目的 分析B型尿钠肽(BNP)在早期早产儿有血流动力学意义的动脉导管未闭(hsPDA)诊治中的价值.方法 2012年1月至2015年5月东南大学附属徐州医院NICU收治的符合入选标准的早期早产儿(胎龄＜ 34周)271例,其中hsPDA组63例,无血流动力学意义的动脉导管未闭(nhsPDA)组82例,无动脉导管未闭(nPDA)组126例(按照hsPDA∶nPDA为1∶2的比例纳入).在出生第2-3天检测血浆BNP水平,出生第3-7天筛查超声心动图.hsPDA组予药物治疗72 h后复查超声心动图.采用SPSS 20.0软件处理数据.结果 血浆BNP水平在hsPDA组[572(251,924) ng/L]与nhsPDA组[171(147,541) ng/L]之间、hsPDA组与nPDA组[188(141,250) ng/L]之间差异有统计学意义(Z=-4.069、-6.365,P=0.000、0.000),nhsPDA组与nPDA组之间差异无统计学意义(Z=-1.674,P=0.094).出生第2-3天,血浆BNP水平预测早产儿hsPDA的受试者工作特征(ROC)曲线下面积为0.750(95％ CI0.672 ～ 0.828),有统计学意义(P=0.000).最佳界值为292.5 ng/L,敏感度为75.4％,特异度为77.6％;预测早产儿hsPDA药物治疗失败的ROC曲线下面积为0.540(95％CI0.351 ～0.729),无统计学意义(P =0.640).出生第2-3天血浆BNP水平与动脉导管分流量(左心房内径/主动脉内径)及直径有显著正相关性(偏相关系数=0.365、0.370,P=0.000、0.000).结论 早期早产儿出生第2-3天血浆BNP水平有助于预测早产儿发生hsPDA,且与动脉导管分流量及直径存在显著正相关,但无法很好地预测药物治疗hsPDA失败.血浆BNP水平范围过大,呈偏态分布,影响了其在早期早产儿hsPDA诊治的临床应用价值.%Objective To analyze the value of B-type natriuretic peptide (BNP) in the diagnosis and treatment of haemodynamically significant patent ductus arteriosus (hsPDA) in the early preterm infants.Methods The 271 early preterm infants (gestational age ＜ 34 weeks) admitted to NICU of the Affiliated Xuzhou Hospital of Southeast University from January 2012 to May 2015 chosen by adoption standards were divided into the hsPDA group (63 cases),the non-hsPDA group (nhsPDA group,82 cases) and the non-patent ductus arteriosus group (nPDA group,126 cases) (hsPDA:nPDA =1:2).The plasma BNP was tested on 2-3 d after birth,and the echocardiography was done on 3-7 d after birth which was reexamined at 72 h after drug treatment in hsPDA group.SPSS 20.0 software was used for data analysis.Results There was significant difference in plasma BNP levels between the hsPDA group [572 (251,924) ng/L] and nhsPDA group [171 (147,541) ng/L] and also between hsPDA group and nPDA group [188 (141,250) ng/L] (Z =-4.069,-6.365;P =0.000,0.000),but there was no significant difference between nhsPDA group and nPDA group(Z =-1.674,P =0.094).The area under receiver operating characteristic (ROC) curve of the plasma BNP levels for prediction of hsPDA in the early preterm infants on 2-3 d after birth was 0.750 (95％ CI0.672-0.828),and it has statistical significance (P =0.000).The optimal boundary value of the plasma BNP levels was 292.5 ng/L,sensitivity was 75.4％ and specificity was 77.6％,respectively.There was no statistical significance of the area under the ROC curve of the plasma BNP levels,which predicted the area under the ROC curve after drug treatment failure for hsPDA in preterm infants was 0.540 (95％ CI 0.351-0.729).There was significantly positive correlation between the plasma BNP levels on 2-3 d after birth and the arterial flow (left atrial diameter/aortic diameter) and diameter of the ductus arteriosus (partial correlation coefficients =0.365,0.370;P =0.000,0.000).Conclusions The plasma BNP levels of early preterm infants on 2-3 d after birth can help predict the probability of hsPDA occurrence in preterm infants,and is significantly positively correlated with the magnitudes of the ductal shunt and the diameter of the ductus arteriosus,but it can not help predict the probability of failure of drug treatment for hsPDA well.The rang of the plasma BNP levels is too large with skewed distribution,which affects its value of clinical application in the diagnosis and treatment of hsPDA in the early preterm infants.
展开▼
