Clinical value of N-terminal pro-B-type natriuretic peptide in bronchopulmonary dysplasia of premature infants
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摘要:目的
探讨氨基末端脑钠肽前体(NT-proBNP)水平在早产儿支气管肺发育不良(BPD)中的临床价值。
方法选取81例早产儿, 根据BPD的诊断标准将其分为BPD组(38例)和非BPD组(43例), 再根据相关分级标准将BPD组分为轻度BPD组(20例)和中重度BPD组(18例)。收集早产儿资料及母亲资料, 并统计出生后1、14、28 d血浆NT-proBNP水平。
结果BPD组早产儿胎龄、出生体质量小于非BPD组, 且中重度BPD组小于轻度BPD组, 差异有统计学意义(P < 0.05)。BPD组早产儿有创通气时间≥7 d者占比、合并早产儿视网膜病变(ROP)者占比高于非BPD组, 且中重度BPD组高于轻度BPD组, 差异有统计学意义(P < 0.05)。出生后1、14、28 d, BPD组早产儿血浆NT-proBNP水平高于非BPD组早产儿, 且中重度BPD组高于轻度BPD组, 差异有统计学意义(P < 0.05)。受试者工作特征(ROC)曲线分析显示, 出生后1、14、28 d血浆NT-proBNP水平预测早产儿BPD的最佳截断值分别为4 233.5 pg/mL (敏感度57.9%, 特异度83.7%)、2 152.0 pg/mL (敏感度89.5%, 特异度79.1%)、1 085.5 pg/mL (敏感度94.7%, 特异度79.1%)。出生后1、14、28 d血浆NT-proBNP水平预测早产儿中重度BPD的最佳截断值分别为4 918.0 pg/mL (敏感度66.7%, 特异度85.0%)、4 778.0 pg/mL (敏感度100.0%, 特异度90.0%)、2 801.0 pg/mL (敏感度88.9%, 特异度100.0%)。
结论NT-proBNP水平与早产儿BPD有一定的相关性, 可在一定程度上反映病情严重程度。动态监测血浆NT-proBNP水平有助于早产儿BPD的早期诊断及风险分层, 有利于早期干预治疗和改善预后
Abstract:ObjectiveTo investigate the clinical value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in bronchopulmonary dysplasia (BPD) of premature infants.
MethodsEighty-one premature infants were selected and divided into BPD group (38 cases) and non-BPD group (43 cases) according to the diagnostic criteria of BPD.The BPD group was then divided into mild BPD group (20 cases) and moderate-severe BPD group (18 cases) according to relevant grading standards.The data of premature infants and mothers were collected, and the plasma NT-proBNP levels at 1day, 14 and 28 days after birth were analyzed.
ResultsThe gestational age and birth weight of premature infants in the BPD group were significantly lower than those in the non-BPD group, and those in the moderate-severe BPD group were significantly lower than those in the mild BPD group (P < 0.05).The proportions of invasive ventilation duration ≥7 d and complicating with retinopathy of prematurity (ROP) in the BPD group were significantly higher than those in the non-BPD group, and those in the moderate-severe BPD group were higher than those in the mild BPD group (P < 0.05).The plasma NT-proBNP levels in the BPD group were significantly higher than those in the non-BPD group at 1 day, 14 and 28 days after birth, and those in the moderate-severe BPD group were significantly higher than that in the mild BPD group (P < 0.05).Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off values of plasma NT-proBNP level for predicting premature BPD at 1day, 14 and 28 days after birth were 4 233.5 pg/mL (sensitivity of 57.9%, specificity of 83.7%), 2 152.0 pg/mL (sensitivity of 89.5%, specificity of 79.1%) and 1 085.5 pg/mL (sensitivity of 94.7%, specificity of 79.1%), respectively.The optimal cut-off values of plasma NT-proBNPlevel at 1 day, 14 and 28 days after birth for predictingmoderate-severe BPD in premature infants were 4 918.0 pg/mL (sensitivity of 66.7%, specificity of 85.0%), 4 778.0 pg/mL (sensitivity of 100.0%, specificity of 90.0%) and 2 801.0 pg/mL (sensitivity of 88.9%, specificity of 100.0%), respectively.
ConclusionThere was a certain correlation between NT-proBNP level and premature BPD, which could reflect the severity of the disease to a certain extent.Dynamic monitoring of plasma NT-proBNP level is conducive to the early diagnosis and risk stratification of premature BPD, and is conducive to early intervention and treatment as well as improvement of prognosis.
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表 1 早产儿一般资料比较(x±s)[n(%)]
一般资料 n 非BPD组(n=43) BPD组(n=38) 轻度BPD组(n=20) 中重度BPD组(n=18) 男性 46 25(58.1) 11(55.0) 10(55.6) 合并妊娠期高血压 16 8(18.6) 4(20.0) 4(22.2) 合并妊娠期糖尿病 17 7(16.3) 5(25.0) 5(27.7) 母亲孕期炎症 32 16(37.2) 8(40.0) 8(44.4) 产前使用糖皮质激素 65 36(83.7) 16(80.0) 13(72.2) 1 min Apgar评分≤5分 15 7(16.3) 4(20.0) 4(22.2) 5 min Apgar评分≤5分 11 5(11.6) 3(15.0) 3(16.7) 坏死性小肠结肠炎 10 4(9.3) 3(15.0) 3(16.7) 脑室内出血(3期或4期) 10 4(9.3) 3(15.0) 3(16.7) 有创通气时间≥7 d 19 3(6.9)* 7(35.0) 9(50.0)# 产后使用肺泡表面活性物质 78 41(95.3) 19(95.0) 18(100.0) 早产儿视网膜病变 19 4(9.3)* 7(35.0) 8(44.4)# 肝功能异常 5 2(4.7) 1(5.0) 2(11.1) 贫血(重度或极重度) 54 25(58.1) 14(70.0) 15(83.3) 甲状腺功能异常 31 15(34.9) 8(40.0) 8(44.4) 胎龄/周 - 30.6±0.9* 29.2±1.1 28.3±1.2# 出生体质量/g - 1 315.3±135.7* 1 211.5±150.1 1 001.7±181.2# 与BPD组比较, * P < 0.05; 与轻度BPD组比较, #P < 0.05。 
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表 2 非BPD组与BPD组早产儿血浆NT-proBNP水平比较[M(P25, P75)]
pg/mL 时点 非BPD组(n=43) BPD组(n=38) 出生后1 d 3 287.0(2 763.0, 3 927.0) 4 407.0(3 287.5, 5 654.3)* 出生后14 d 1 567.0(1 265.0, 2 109.0) 4 954.5(2 778.0, 9 392.0)* 出生后28 d 675.0(557.0, 1 030.0) 2 278.0(1 282.5, 3 825.0)* 与非BPD组比较, * P < 0.05。
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表 3 轻度与中重度BPD组早产儿血浆NT-proBNP水平比较[M(P25, P75)]
pg/mL 时点 轻度BPD组(n=20) 中重度BPD组(n=18) 出生后1 d 3 841.0(3 034.8, 4 535.5) 5 566.5(4 194.3, 9 293.5)* 出生后14 d 2 962.5(2 158.3, 4 150.5) 9 497.0(7 552.0, 16 801.3)* 出生后28 d 1 307.0(1 116.0, 2 164.8) 3 833.0(3 125.0, 6 955.5)* 与轻度BPD组比较, * P < 0.05。
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表 4 血浆NT-proBNP水平预测早产儿BPD发生的ROC曲线分析
时点 曲线下面积 95%CI 最佳截断值/(pg/mL) 敏感度/% 特异度/% 出生后1 d 0.760 0.657~0.863 4 233.5 57.9 83.7 出生后14 d 0.926 0.874~0.978 2 152.0 89.5 79.1 出生后28 d 0.940 0.895~0.986 1 085.5 94.7 79.1
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表 5 血浆NT-proBNP水平预测早产儿中重度BPD的ROC曲线分析
时点 曲线下面积 95%CI 最佳截断值/(pg/mL) 敏感度/% 特异度/% 出生后1 d 0.818 0.685~0.952 4 918.0 66.7 85.0 出生后14 d 0.992 0.973~1.000 4 778.0 100.0 90.0 出生后28 d 0.968 0.919~1.000 2 801.0 88.9 100.0
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