目的 探讨N末端脑钠肽前体(NT-proBNP)与心肌肌钙蛋白Ⅰ(cTnⅠ)评价新生儿呼吸窘迫综合征(NRDS)预后的临床价值,为临床医师提供参考。方法 选取2015年4月-2018年4月榆林市第一医院收治的110例NRDS患儿为病例组,同期选择本院60例非NRDS新生儿为对照组;并将NRDS患儿预后情况分为存活组与死亡组,比较各组一般临床资料的差异。同时采用Logistic回归方程分析NT-proBNP和cTnⅠ与NRDS患儿死亡的关系;采用ROC曲线评估两者预测NRDS发生的价值。结果 病例组血浆NT-proBNP和cTnⅠ显著高于对照组,差异有统计学意义(t=24.329、51.075,P<0.05)。与存活组比较,死亡组出生时体重、氧合指数(PaO2/FiO2)水平较低,肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)较高,差异有统计学意义(P<0.05);死亡组血浆NT-proBNP和cTnⅠ高于存活组,差异有统计学意义(P<0.05)。Ⅳ级NRDS患儿NT-proBNP和cTnⅠ水平高于Ⅰ级～Ⅲ级,Ⅲ级高于Ⅱ级和Ⅰ级,差异有统计学意义(P<0.05)。Spearman秩相关分析提示NT-proBNP和cTnI分别与NRDS严重程度分级呈正相关(r=0.329、0.287,P<0.05)。多元Logistic回归方程提示NT-proBNP(OR=3.115,95%CI:2.249~7.184)和cTnⅠ(OR=2.376,95%CI:1.582~6.110)是NRDS患儿死亡的危险因素(P<0.05)。NT-proBNP和cTnⅠ预测NRDS患儿死亡的ROC曲线下面积分别为0.769和0.691,两组联合预测的ROC曲线下面积显著高于两者单独预测面积,差异具有统计学意义(Z=2.854,P<0.05)。结论 NT-proBNP和cTnⅠ水平与NRDS患儿病情严重程度呈正相关,可能是此类患儿死亡的危险因素,两者联合检测在预测患儿预后方面具有较高的临床价值。
Abstract
Objective To explore the clinical value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin Ⅰ(cTnⅠ) in evaluating the prognosis of neonatal respiratory distress syndrome (NRDS),in order to provide reference for clinical practice. Methods Totally 110 children with NRDS hospitalized in Yulin First Hospital from April 2015 to April 2018 were enrolled in this study as the case group,and 60 infants without NRDS in the meantime were selected as control.Children with NRDS were divided into survival group and death group according to the prognosis.Differences on general clinical data among each group were compared.Logistic regression equation was used to analyze the relationship between the death of NRDS children and the levels of NT-proBNP and cTnⅠ.And ROC curve was used to evaluate the predictive value of NRDS. Results Plasma levels of NT-proBNP and cTnⅠ in case group were significantly higher than those in control group(t=24.329,51.075,P＜0.05).Compared with survival group,birth weight,oxygen index (PaO2/FiO2) were lower and the levels of creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) were significantly higher in the death group(P＜0.05).Plasma levels of NT-proBNP and cTnⅠ in death group were significantly higher than those in survival group (P<0.05).NT-proBNP and cTnⅠ levels in children with grade Ⅳ NRDS were significantly higher than those in children with grade Ⅰ-Ⅲ NRDS,so was in grade Ⅲ NRDS than those in grade Ⅰ-Ⅱ NRDS (P<0.05).Spearman rank correlation analysis indicated that the levels of NT-proBNP and cTnⅠ were positively correlated with NRDS severity respectively (r=0.329,0.287,P<0.05).Multiple Logistic regression equation suggested that NT-proBNP (OR=3.115,95%CI:2.249-7.184) and cTnⅠ(OR=2.376,95%CI:1.582-6.110) were risk factors of death (P<0.05).The area under ROC curve of NT-proBNP and cTnⅠ in predicting death of NRDS children was 0.769 and 0.691,respectively.The area under the ROC curve predicted by the two groups was significantly higher than that predicted by the two groups alone (Z=2.854,P<0.05). Conclusions The levels of NT-proBNP and cTnⅠ are positively correlated with the severity of NRDS,which may be risk factors for the death of NRDS children.Moreover,the combined detection of NT-proBNP and cTnⅠ levels has a high clinical value in predicting the prognosis.
关键词
N末端脑钠肽前体 /
肌钙蛋白Ⅰ /
新生儿呼吸窘迫综合征
Key words
N-terminalpro-brainnatriureticpeptide /
cardiactroponinⅠ /
neonatalrespiratorydistresssyndrome
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