摘要
目的探讨N末端脑钠肽前体(NT-proBNP)在早期评估脓毒症新生儿心功能障碍中的意义。方法回顾性分析2016年1月至2019年1月聊城市人民医院儿科新生儿重症监护病房(NICU)收治的脓毒症新生儿及同期住院的一般感染患儿的相关资料。收集患儿临床、实验室、床边超声心动图检查和生存数据,比较脓毒症有心功能障碍和无心功能障碍及一般感染患儿各临床指标的差异;采用多因素Logistic回归分析脓毒症新生儿心功能障碍的危险因素,用受试者工作特征曲线(ROC)分析NT-proBNP对脓毒症新生儿心功能障碍的预测价值。结果112例脓毒症新生儿(心功能障碍49例、无心功能障碍63例)和67例一般感染患儿纳入分析。脓毒症心功能障碍组新生儿发病时间明显早于脓毒症无心功能障碍组和一般感染组〔h:52.9(0,180.3)比53.9(0,183.6)、81.0(45.6,202.4),均P<0.05〕。与一般感染组比较,脓毒症心功能障碍组白蛋白(ALB)、白细胞计数(WBC)、左室射血分数(LVEF)明显降低,NT-proBNP、超敏C-反应蛋白(hs-CRP)/ALB比值、肺动脉收缩压(PASP)明显升高,右室内径(RV)、Tei指数明显增加〔ALB(g/L):24.1±3.8比27.8±3.6,WBC(×10^9/L):12.7(3.7,18.9)比15.4(9.9,23.2),LVEF:0.626±0.123比0.700±0.021,NT-proBNP(ng/L):20230.6(15890.0,35000.0)比7324.5(2426.5,13890.0),hs-CRP/ALB:0.33(0.29,0.81)比0.06(0.00,0.21),PASP(mmHg,1 mmHg=0.133 kPa):52.25±14.12比41.07±27.73,RV(mm):10.74±2.42比8.55±1.41,Tei指数:0.52±0.03比0.30±0.04,均P<0.05〕;且脓毒症心功能障碍组NT-proBNP、Tei指数明显高于脓毒症无心功能障碍组〔NT-proBNP(ng/L):20230.6(15890.0,35000.0)比13057.6(8946.0,35000.0),Tei指数:0.52±0.03比0.39±0.02,均P<0.05〕,LVEF明显低于脓毒症无心功能障碍组(0.626±0.123比0.671±0.086,P<0.05)。多因素Logistic回归分析显示,NT-proBNP、Tei指数、hs-CRP/ALB是脓毒症新生儿发生心功能障碍的独立危险因素〔优势比(OR)和95%可信区间(95%CI)分别为8.73(1.54~5.67)、1.97(1.26~2.87)、1.87(1.03~3.40),均P<0.05〕。ROC曲线分析显示,NT-proBNP、Tei指数、hs-CRP/ALB对脓毒症新生儿心功能障碍的发生有较高的预测价值,ROC曲线下面积(AUC)分别为0.81(95%CI为0.84~0.91)、0.78(95%CI为0.65~0.79)和0.77(95%CI为0.61~0.77)。其中,NT-proBNP以12291.5 ng/L为截点值时敏感度为80.0%,特异度为79.0%;Tei指数以0.45为截点值时敏感度为74.0%,特异度为77.0%;hs-CRP/ALB以0.10为截点值时敏感度为76.0%,特异度为76.3%。结论NT-proBNP可作为早期心功能障碍的诊断标志物,快速诊断脓毒症新生儿心功能障碍,以更好地指导临床医师用药,改善患儿心功能,提高治疗效果。
Objective To investigate the significance of N-terminal pro-brain natriuretic peptide(NT-proBNP)in the early assessment of neonatal cardiac dysfunction in sepsis.Methods The children diagnosed with neonatal sepsis and common infection neonates admitted to the department of pediatric neonatal intensive care unit(NICU)of Liaocheng People's Hospital from January 2016 to January 2019 were enrolled.Data of clinical sign,laboratory results,bedside echocardiography and survival data were collected,and the differences of clinical indexes were compared among sepsis patients with and without cardiac dysfunction and common infection.The risk factors of sepsis with cardiac dysfunction were analyzed by multivariate Logistic regression,and the early prediction value of NT-proBNP for neonatal septic cardiac dysfunction was evaluated by the receiver operating characteristic(ROC)curve.Results There were 112 neonates with sepsis(49 with cardiac dysfunction and 63 without cardiac dysfunction)and 67 children with common infection included in the analysis.The onset time of neonates in septic cardiac dysfunction group was significantly earlier than that of septic non-cardiac dysfunction group and common infection group[hours:52.9(0,180.3)vs.53.9(0,183.6),81.0(45.6,202.4),both P<0.05].Compared with the general infection group,albumin(ALB),white blood cell count(WBC),left ventricular ejection fraction(LVEF)in septic cardiac dysfunction group significantly decreased,NT-proBNP,hypersensitive C-reactive protein(hs-CRP)/ALB,pulmonary artery systolic pressure(PASP)significantly increased,while right ventricular(RV)and Tei index significantly increased[ALB(g/L):24.1±3.8 vs.27.8±3.6,WBC(×10^9/L):12.7(3.7,18.9)vs.15.4(9.9,23.2),LVEF:0.626±0.123 vs.0.700±0.021,NT-proBNP(ng/L):20230.6(15890.0,35000.0)vs.7324.5(2426.5,13890.0),hs-CRP/ALB:0.33(0.29,0.81)vs.0.06(0.00,0.21),PASP(mmHg,1 mmHg=0.133 kPa):52.25±14.12 vs.41.07±27.73,RV(mm):10.74±2.42 vs.8.55±1.41,Tei index:0.52±0.03 vs.0.30±0.04,all P<0.05].NT-proBNP and Tei index in septic cardiac dysfunction group were significantly higher than those in septic non-cardiac dysfunction group[NT-proBNP(ng/L):20230.6(15890.0,35000.0)vs.13057.6(8946.0,35000.0),Tei index:0.52±0.03 vs.0.39±0.02,both P<0.05],and LVEF was significantly lower than that in septic non-cardiac dysfunction group(0.626±0.123 vs.0.671±0.086,P<0.05).Multivariate Logistic regression analysis showed that NT-proBNP,Tei index and hs-CRP/ALB were independent risk factors for cardiac dysfunction in sepsis neonates[odds ratio(OR)and 95%confidence interval(95%CI)were 8.73(1.54-5.67),1.97(1.26-2.87),1.87(1.03-3.40)respectively,all P<0.05].ROC curve analysis showed that NT-proBNP,Tei index and hs-CRP/ALB had good predictive value for the occurrence of cardiac dysfunction in septic neonates,the area under ROC curve(AUC)was 0.81(95%CI was 0.84-0.91),0.78(95%CI was 0.65-0.79)and 0.77(95%CI was 0.61-0.77),respectively.The sensitivity and specificity of NT-proBNP were 80.0%and 79.0%respectively with 12291.5 ng/L as the cut-off value,the sensitivity and specificity of Tei index were 74.0%and 77.0%respectively with 0.45 as the cut-off value,and the sensitivity and specificity of hs-CRP/ALB were 76.0%and 76.3%respectively with 0.10 as the cut-off value.Conclusions NT-proBNP can be used as a diagnostic marker of early cardiac dysfunction,and for rapid diagnosis of neonatal cardiac dysfunction in sepsis.The application may guide clinicians to use drugs better to improve cardiac function and treatment effect.
作者
杨春燕
刘凤敏
韩梅盈
李宝云
申青华
许平
杨巧芝
Yang Chunyan;Liu Fengmin;Han Meiying;Li Baoyun;Shen Qinghua;Xu Ping;Yang Qiaozhi(Department of Pediatric Neonatal Intensive Care Unit,Liaocheng People's Hospital,Liaocheng 252000,Shandong,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第6期711-715,共5页
Chinese Critical Care Medicine
基金
山东省重点研发计划项目(2018GSF118173)
山东省医药卫生科技发展计划项目(2017WS218)。
关键词
婴儿
新生
N末端脑钠肽前体
脓毒症
心功能障碍
超声心动图
Infant
newborn
N-terminal pro-brain natriuretic peptide
Sepsis
Cardiac dysfunction
Echocardiography
