血清NT-proBNP和肌钙蛋白Ⅰ与肺炎合并心力衰竭患儿改良Ross评分的相关性分析
| 作者: |
1夏翠林
1 浠水县人民医院儿科，湖北 黄冈 438200 |
| 通讯: |
夏翠林
Email: xiacuilin@126.com |
| DOI: | 10.3978/j.issn.2095-6959.2015.12.025 |
摘要
目的：探讨血浆氨基N末端B型利钠肽前体(NT-proBNP)和肌钙蛋白Ⅰ(cTnI)与肺炎合并心力衰竭患儿改良Ross评分的相关性分析。方法：选取2013年1月至2014年12月我院收治的支气管肺炎患儿102例为研究对象，依据入院时小儿心力衰竭改良Ross评分分为无心力衰竭组、轻度心力衰竭组及中–重度心力衰竭组，检测患儿入院时血清NT-proBNP、cTnI，并记录患儿心脏超声指标左室射血分数(left ventricular ejection fraction，LVEF)以及左室缩短分数(left ventricular shortening fraction，LVFS)，同期选取我院健康体检的婴幼儿50例作为参照对照组。结果：四组患者血清NT-proBNP、cTnI、LVEF、LVFS之间比较具有统计学差异(P<0.05)，中–重度心力衰竭组NT-proBNP、cTnI高于轻度心力衰竭组、无心力衰竭组及对照组，轻度心力衰竭组高于无心力衰竭组及对照组；中–重度心力衰竭组LVEF、LVFS高于轻度心力衰竭组、无心力衰竭组及对照组，轻度心力衰竭组高于无心力衰竭组及对照组；中–重度心力衰竭组及轻度心力衰竭组治疗后7 d的NT-proBNP、cTnI均较治疗前下降(P<0.05)，但中–重度心力衰竭组7 d的NT-proBNP、cTnI仍高于轻度心力衰竭组(P<0.05)；多重线性回归分析显示：NT-proBNP、cTnI分别与Ross评分呈正相关，而与LVEF呈负相关(P<0.05)；ROC曲线分析显示：入院治疗前血清NT-proBNP、cTnI预测肺炎患儿发生心力衰竭(改良Ross评分≥3分)的曲线下面积(ROCAUC)分别为：0.882、0.823；灵敏度分别为：90.1%，87.9%；特异度分别为：79.6%，78.1%。结论：血清NT-proBNP、cTnI与肺炎合并心衰患儿心衰病情严重程度密切相关，两者均能够评估患儿心力衰竭分级状态，且NT-proBNP在诊断心衰的临床价值方面优于cTnI。
关键词：
氨基N末端B型利钠肽前体
肌钙蛋白Ⅰ
心力衰竭
改良Ross评分
Correlation of serum NT-proBNP and troponin I with modified Ross score in children with pneumonia complicated heart failure
CorrespondingAuthor: XIA Cuilin Email: xiacuilin@126.com
DOI: 10.3978/j.issn.2095-6959.2015.12.025
Abstract
Objective: To investigate the correlation of serum NT-proBNP and troponin I (cTnI) with modified Ross score in children with pneumonia complicated heart failure. Methods: A total of 102 cases of children with bronchial pneumonia in our hospital from January 2013 to December 2013. Selected as the research subjects, all children were divided into non-heart failure group, mild heart failure group and severe heart failure group on the basis of modified Ross score, serum NT-proBNP, cTnI were detected when children admitted to hospital, and recorded the left ventricular ejection fraction (LVEF) and left ventricular shortening fraction (LVFS); healthy check-up infants and young children were choose as control group at the same time. Results: There were statistically difference in NT-proBNP, cTnI, LVEF and LVFS among four groups (P<0.05); serum NT-proBNP, cTnI level of severe heart failure group were higher than those of mild, non-heart failure and control group; serum NT-proBNP, cTnI level of mild heart failure group were higher than those of non-heart failure and control group (P<0.05); LVEF and LVFS of severe heart failure group were lower than those of mild, non-heart failure and control group (P<0.05); LVEF and LVFS of mild heart failure group were lower than those of non-heart failure and control group (P<0.05); serum NT-proBNP, cTnI level of severe, mild heart failure group decreased after 7 d treatment (P<0.05), however, serum NT-proBNP, cTnI level of severe heart failure group were higher than those of mild heart failure group (P<0.05); multiple linear regression analysis showed that NT-proBNP and cTnI were positively correlated with modified Ross score, and negative correlated with LVEF (P<0.05); ROC curve analysis showed that ROCAUC of serum NT-proBNP and cTnI predicting the heart failure (modified Ross score≥3 points) were 0.882, 0.823, respectively; sensitivity were 90.1%, 87.9% respectively: specific degrees were 79.6%, 79.6%, respectively. Conclusion: Serum NT-proBNP, cTnI are closely related to heart failure severity in children with pneumonia, both indexes are used to assess classification status of heart failure; and NT-proBNP is better than that of cTnI in terms of the clinical value of diagnosis of heart failure.