N端脑钠肽原在新生儿窒息后心肌损伤中的检测及意义

目的探讨新生儿窒息后各项心肌损伤的指标、心肌酶谱等的变化及与各种围生因素的相关性。方法随机选择99例窒息患儿为研究对象（轻度窒息54例,重度窒息45例;心肌损伤47例,非心肌损伤52例）,以45例健康新生儿为对照组。采用酶联免疫吸附试验（ELISA）测定血浆N端脑钠肽原（NT-proBNP）水平,同时检测心肌酶、肌钙蛋白I、心电图、X线胸片等。结果心肌损伤组血浆NT-proBNP水平明显高于非心肌损伤组和对照组（P〈0.01）;重度窒息组血浆NT-proBNP水平明显高于轻度窒息组和对照组（P〈0.01）;Spearman秩和相关分析显示,窒息患儿血浆NT-proBNP水平与肌酸激酶同工酶、肌酸激酶、乳酸脱氢酶呈显著正相关（P〈0.01）。结论 NT-proBNP可作为窒息新生儿早期心肌损伤的生化标志物,对于早期发现窒息合并心肌损伤、判断病情程度、指导治疗具有重要的临床意义。

Plasma levels of N-terminal pro-brain natriuretic peptide with asphyxia complicated by myocardial in jury and the clinical significance

Objective To investigate the changes and the clinical significance of N-terminal pro-brain natriuretic peptide（NT-proBNP） levels in neonates with asphyxia complicated by myocardial injury.Methods Ninety-nine neonates with asphyxia（54 mild,45 severe） were enrolled.Of the 99 neonates,47 had myocardial injury and 52 did not develop myocardial injury.Forty-five healthy neonates served as a control group.Plasma levels of NT-proBNP were measured by using ELISA,Myocardial enzymes and cardiac troponin I were simultaneously measured,and electro cardiograph and chest radiographs were obtained.Results The plasma levels of NT-proBNP in neonates with myocardial injury were significantly higher than those in neonates without myocardial injury and in the control group（P0.01）.The neonates with severe asphyxia had significantly increased plasma NT-proBNP comparing to those with mild asphyxia and the control group（P0.01）.Spearman rank correlation analysis showed that plasma NT-proBNP level was positively correlated in neonates with asphyxia.Plasma levels of NT-proBNP were also positively correlated with plasma levels of CK-MB,CK and LDH（P0.01）.Conclusion NT-proBNP can be used as the biomarker of myocardial injury in neonates with asphyxia.The measurement of plasma NT-proBNP levels is useful in early identification of myocardial injury and severity evaluation in neonates with asphyxia.