心力衰竭患儿外周血BNP、hs-CRP、cTnI的变化及其与病情及预后的相关性

摘要

Objective To investigate the changes of B-type brain natriuretic peptide (BNP), high-sensitivity C-reactive protein (hs-CRP), troponin (cTnI) in peripheral blood of children with heart failure and their correlation with disease and prognosis. Methods A total of 103 cases of hospitalized children with heart failure, who admitted to De-partment of Pediatrics in our hospital from January 2014 to September 2016, were selected and divided into the mild group (n=24), moderate group (n=41) and severe group (n=38) according to modified Ross score. The peripheral blood BNP, hs-CRP, cTnI levels were detected immediately on admission and after 5 d of the treatment. Using the improved Ross score as a reference, Pearson correlation analysis was used to analyze its correlation with disease severity. Of the 103 children, 92 were alive, 11 were dead, and the correlation of the BNP, hs-CRP, cTnI to prognosis were analyzed by Pearson correlation analysis. Results There was significant difference between the mild, moderate, and severe group in the levels of BNP, hs-CRP and cTnI on admission (P<0.05). At the fifth day of treatment, the levels of BNP, hs-CRP and cTnI in the severe group were significantly higher than those in mild group and moderate group;the level of BNP in the moderate group was significant higher than that in the mild group (P<0.05);there was no significant difference between the mild and moderate group in the levels of hs-CRP and cTnI (P>0.05). The survival rate of the children in the mild group was 100.00%, 90.24% in the moderate group, 81.58% in the severe group, and the difference in survival rates were statistically significant (P<0.05). At the fifth day of treatment, the levels of BNP, the hs-CRP, and cTnI in the dead children of the severe group were significantly higher than those in the children who were alive (P<0.05);there was no significant difference between the dead children of the mild, moderate and servere group in the levels of BNP, hs-CRP, and cTnI (P>0.05). The levels of BNP, hs-CRP and cTnI in patients with heart failure were positively correlated with the severity of the disease (r=0.747, 0.562, 0.381), and negatively correlated with prognosis (r=-0.817,-0.741,-0.776). Conclusion The levels of peripheral blood BNP, hs-CRP, cTnI were positively correlated with the severity of the dis-ease in children with heart failure, and negatively correlated with the prognosis, which can be used as a secondary indica-tor for diagnosis and treatment.%目的 探讨心力衰竭患儿外周血B型脑钠肽(BNP)、高敏C反应蛋白(hs-CRP)、肌钙蛋白(cTnI)的变化及其与病情及预后的相关性.方法 选择深圳市龙华新区人民医院儿科2014年1月至2016年9月收治的103例住院心力衰竭患儿,采用改良Ross评分分为轻度组24例,中度组41例,重度组38例,于入院时即刻、治疗5 d后抽取外周血分别检测BNP、hs-CRP、cTnI水平,以改良Ross评分作为参考,采用Pearson相关分析其与病情严重程度的相关性.103例患儿中存活92例,死亡11例,采用Pearson相关分析BNP、hs-CRP、cTnI水平与预后的相关性.结果 轻度组、中度组、重度组患儿入院即刻BNP、hs-CRP、cTnI水平比较差异均有统计学意义(P<0.05);治疗5 d时重度组患儿的BNP、hs-CRP、cTnI水平均高于轻度组和中度组,中度组患儿BNP水平高于轻度组,差异均有统计学意义(P<0.05),而轻度组和中度组患儿治疗5 d时的hs-CRP、cTnI水平比较差异均无统计学意义(P>0.05);轻度组患儿的存活率为100.00%,中度组存活率为90.24%,重度组存活率为81.58%,组间存活率比较差异均有统计学意义(P<0.05);治疗5 d时中、重度组死亡患儿BNP、hs-CRP、cTnI水平明显高于存活患儿,差异均有统计学意义(P<0.05).轻、中、重度组死亡患儿BNP,hs-CRP、cTnI水平差异均无统计学意义(P>0.05).心力衰竭患儿BNP、hs-CRP、cTnI水平与病情严重程度呈正相关(r=0.747,0.562,0.381),与预后呈负相关(r=-0.817,0.741,0.776).结论 外周血BNP、hs-CRP、cTnI水平与心力衰竭患儿病情严重程度呈正相关,与预后呈负性相关,可作为诊断及治疗的辅助指标.