急性心力衰竭患儿血浆脑钠素及心钠素水平的变化

目的探讨急性心力衰竭患儿血浆脑钠素(BNP)及心钠素(ANP)水平变化及其意义。方法选择不同病因的充血性心力衰竭(CHF)患儿46例及肺炎患儿40例、先天性心脏病患儿31例、健康儿童40例,应用酶联免疫吸附法分别检测血浆BNP及ANP水平,用多普勒超声心动图测量心力衰竭患儿心衰期及恢复期心脏指数(CI)及左室射血分数(LVEF)。结果CHF患儿心衰前期BNP即开始升高,心衰时达高峰(P<0.001),恢复期BNP水平渐下降,但仍高于正常值(P<0.001);心衰时心脏CI、LVEF均明显下降(P<0.01);CHF患儿心衰时升高的BNP水平与CI、LVEF均呈明显负相关(r=-0.61,0.79P均<0.05);同时测定的ANP动态变化趋势与BNP类似;CHF患儿心衰时的BNP/ANP比值远远高于正常对照;心衰时BNP与ANP异常率比较有显著差异(P<0.05);心衰时BNP水平与LVEF、CI值相关性优于ANP。结论CHF患儿血清BNP及ANP水平明显升高.且与心衰程度关系密切,BNP反映心脏功能改变较ANP更敏感,更具有特异性。

Changes of Brain Natriuretic Peptide and Atrial Natriuretic Peptide in Serum of Children with Congestive Heart Failure

Objective To study the serum level of brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) in patients with congestive heart failure (CHF) and assess the value of BNP. Methods The serum levels of BNP and ANP were determined by enzyme- linked immnoabsorbent assay.Cardial mdex(CI)and left ventricular election fraction(LVEF)in heart failure stage and period recouery of children with heart failare were determined by Doppler ultrasonography cardiogram. Results The BNP serum levels began to increase before heart failure (P<0.01),and reach the highest level during CHF (P<0.01). There was also a significant increase during the period of recovery . The similar results were determined in ANP. The ratio of BNP/ANP was very significantly higher than that in normal children. There was very significant increase in positive rate of BNP than ANP during CHF (P< 0.05). The correlativi-ty between the plasma levels of BNP, CI and LVEF was better than ANP. Conclusions The serum BNP and ANP levels are significantly high in children with CHF. They are closely related to the degree of heart failure. BNP level has more sensitivity and specificity than ANP.