成人左向右分流先天性心脏病封堵术前NT—proBNP浓度与肺动脉高压的临床意义

目的通过检测成人左向右分流先天性心脏病介入封堵术前血浆氮末端脑钠肽前体（NT—proBNP）浓度，研究NT—proBNP与肺动脉高压（PAH）关系，为临床评价先天性心脏病相关性PAH的程度提供参考。方法2010年6月-2010年10月成功封堵的先天性心脏病患者83例为病例组，选20名健康正常人作为对照组。依据肺动脉平均压（mPAP）将病例组分为4组：正常PAH组（36例）、轻度PAH组（14例）、中度PAH组（12例）、重度PAH组（21例）。所有患者术前均行右心导管检查，测右房、右室压力、肺动脉收缩压（SPAP）、肺动脉平均压（mPAP）、全肺阻力（PVR）。测定患者术前血浆NT—proBNP浓度，分析与肺动脉压力相关性。结果各PAH组血浆NT—proBNP水平明显高于正常对照组，重度PAH组〉中度PAH组〉轻度PAH组〉无PAH组〉正常对照组，差异有统计学意义（P〈0．01）。NT—proBNP水平与mPAP（r=0．893，P=0．000）、SPAP（r=0．921，P=0．000）、PVR（r=0．844，P=0．000）呈正相关。血浆NT—proBNP浓度67．5pg／mL诊断轻度PAH灵敏度92．9％，特异度94．4％，曲线下面积92．9％；147．0pg／mL诊断中度PAH灵敏度91．7％，特异度75．8％，曲线下面积79．5％；236．5pg／mL诊断重度PAH灵敏度95．2％，特异度73．0％，曲线下面积97．8％。结论成人左向右分流先天性心脏病患者血浆NT—proBNP水平随肺动脉压力升高而逐渐增加，可作为评价肺动脉高压的程度的一项指标。

Relation between Plasma NT. proBNP and Pulmonary Artery Hypertension, in Adult with Left - to right Shunt Congenital Heart Disease

Objective To investigate the relation between level of plasma amino - terminal pro - brain natriuretic peptide （NT - proBNP） and pulmonary artery hypertension （PAH） in adult with left - to - right shunt congenital heart disease. Methods Eighty - three patients （pts） with left- to- right shunt congenital heart disease were enrolled as treatment group, and 20 healthy subjects were as control group. Pts in treatment group were divided into four groups according to their pulmonary artery mean pressure ： Non - pul- monary hypertension group （n= 36）, mild pulmonary hypertension group （n= 14）, moderate pulmonary hypertension group （n= 12）, and severe pulmonary hypertension group （n = 21）. The right atrial pressure, right ventricular pressure, and pulmonary artery pressure were measured by right heart catheterization. The plasma NT - proBNP concentrations were assayed. Results There was significant difference in plasma NT - proBNP level before transcatheter closure in the five groups （P〈0.01）. The order of level of plasma NT- proBNP was serious PAH〉moderate PAH〉 mild PAH〉 non - PAH group〉 control group（P〈0.01 ）. There was a positive correlation between NT- proBNP levels, mPAP, SPAP, and PVR before transcatheter closure. The sensitivity for diagnosis of mild PAH was 92.9% at level of 67.50 pg/mL of plasma NT- proBNP. The specificity was 94.4%. 147 pg/mL of plasma NT - proBNP level diagnose moderate PAH with a sensitivity of 91.7% ,and a specificity of 75.80/00. 236.5 pg/mL of plasma NT - proBNP level diagnose serious PAH with a sensitivity of 95.2% ,and a specificity of 73.0% Conclusion The plasma NT - proBNP level of adult left - to - right shunt congenital heart disease was gradually increased with the ei, ating of pulmonary artery pressure. It may be used as a marker to evaluate the degrees of PAH.