摘要
目的 探讨中心静脉压(CVP)与N末端B型利钠肽前体(NT-proBNP)联合监测对重症心力衰竭儿童多脏器功能衰竭(MOF)进展的预测价值。方法 选取2021年1月至2024年8月山西省儿童医院ICU收治的93例重症心力衰竭患儿作为研究对象,入院后监测CVP与NT-proBNP水平,并行超声心动图及相关实验室检查。定期随访心脏及脏器功能变化,采用Spearman相关分析和受试者工作特征(ROC)曲线评估两项指标单独及联合预测MOF的诊断效能。结果 93例患儿基线资料显示心肌损伤标志物、炎症指标及肝肾功能指标存在不同程度异常。动态监测显示,高CVP组患儿的CVP、NT-proBNP水平始终最高,不同CVP分组间左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)和三尖瓣环收缩期位移(TAPSE)的水平差异均具有统计学意义(P<0.001)。各时间点丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血尿素氮(BUN)、肌酐(Scr)在ALT≥50 U/L组与ALT<50 U/L组间差异均有统计学意义(P<0.05)。序贯器官衰竭评估(SOFA)评分随时间下降(P<0.001),不同严重程度组间差异具有统计学意义(P<0.001),高危组评分始终最高。入院时CVP与NT-proBNP水平均与SOFA评分呈正相关(r=0.723,0.795;均P<0.001)。ROC曲线分析表明,CVP与NT-proBNP联合预测MOF的曲线下面积(AUC)为0.921,灵敏度为92.1%,特异度为85.2%,其诊断效能显著优于任一指标单独使用(Delong检验,P均<0.05)。结论 CVP与NT-proBNP联合监测对预测重症心力衰竭患儿MOF进展具有较高的诊断价值,有助于早期识别病情和优化治疗。
Objective To investigate the predictive value of combined monitoring of central venous pressure(CVP)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)for the progression of multiple organ failure (MOF) in children with severe heart failure. Methods A total of 93 children with severe heart fail-ure admitted to the ICU in the hospital from January 2021 to August 2024 were selected. After admission, the levels of CVP and NT-proBNP were measured, and echocardiography and relevant laboratory tests were performed. Regular follow-ups were conducted to monitor changes in cardiac and organ function. Spearman correlation analysis and receiver operating characteristic (ROC) curve were used to evaluate the diagnostic efficacy of the combined monitoring of the 2 indicators for predicting MOF. Results Baseline data of 93 children showed that myocardial injury markers, inflammatory indicators and liver and kidney function indicators were abnormal to varying degrees. Dynamic monitoring showed that the CVP and NT-proBNP levels of children in the high CVP group were always the highest, and the differences in LVEF, LVEDD and TAPSE levels among different CVP groups were statistically significant (P <0.001). At each time point, the differences in ALT, AST, BUN and Scr between the ALT≥50 U/L group and the ALT< 50 U/L group were statistically significant (P <0.05). The SOFA score decreased over time (P <0.001), and the differences among different severity groups were statistically significant (P <0.001), with the high-risk group having the highest score throughout. The CVP and NT-proBNP levels at admission were positively correlated with the sequential organ failure assessment (SOFA) score (r =0.723, 0.795;both P <0.001). ROC curve analysis showed that the area under the curve (AUC) of CVP and NT-proBNP combined for predicting multiple organ failure (MOF) was 0.921, with a sensitivity of 92.1% and a speci-ficity of 85.2%, and its diagnostic efficacy was significantly better than that of any single indicator (De-long test, both P <0.05). Conclusion Combined monitoring of CVP and NT-proBNP has high diagnostic value for predicting the progression of MOF in children with heart failure, which is conducive to the early identification of the condition and optimization of treatment.
作者
许春丽
刘晋文
张芳
翟颖如
XU Chunli;LIU Jinwen;ZHANG Fang;ZHAI Yingru(Department of Pediatric Critical Care Medicine,Shanxi Children's Hospital/Shanxi Maternal and Child Health Care Hospital,Taiyuan 030025,China;Shanxi Bethune Hospital/Shanxi Academy of Medical Sciences/Tongji Shanxi Hospital/Third Hospital of Shanxi Medical University,Taiyuan 030032,China)
出处
《新疆医科大学学报》
2025年第12期1659-1665,1671,共8页
Journal of Xinjiang Medical University
基金
山西省基础研究计划项目(202210338213330)。
关键词
重症心力衰竭
中心静脉压
N末端B型利钠肽前体
多脏器功能衰竭
severe heart failure
central venous pressure(CVP)
N-terminal pro-B-type natriuretic peptide precursor(NT-proBNP)
multiple organ failure(MOF)
