| 摘要: |
| ［摘要］ 目的 探讨超声心动图检查联合高敏心肌肌钙蛋白I（high-sensitivity cardiac troponin I，hs-cTnI）、N端B型脑钠肽前体（N-terminal pro-brain natriuretic peptide，NT-proBNP）测定对新生儿脓毒症患儿心功能评价及预后的早期预测价值。方法 选择2016-12～2019-12在德州市人民医院新生儿重症监护病房住院的新生儿脓毒症患儿85例，根据住院期间心脏收缩功能是否障碍分为心功能障碍组（41例）和心功能正常组（44例）。心功能障碍组根据入院28 d内存活与否分为死亡组（15例）和存活组（26例）。观察各组入院确诊后24 h内外周血hs-cTnI、NT-proBNP及超声心动图指标心输出量（cardiac output，CO）和二尖瓣舒张早期血流速度峰值（early diastolic peak，E）与二尖瓣舒张晚期血流速度峰值（late diastolic peak，A）的比值（E/A）水平；评估各指标对判断心功能及预测患儿预后的价值。结果 心功能障碍组患儿hs-cTnI、NT-proBNP均高于心功能正常组，CO、E/A低于心功能正常组（P<0.05）；死亡组患儿hs-cTnI、NT-proBNP均高于存活组，CO、E/A低于存活组（P<0.05）；脓毒症患儿血清hs-cTnI、NT-proBNP与心脏彩超CO、E/A呈负相关（P<0.05）。ROC曲线分析显示，hs-cTnI、NT-proBNP、CO、E/A及四项指标联合评估脓毒症患儿预后的AUC分别为0.854、0.827、0.769、0.738、0.902，预测价值较高，四项指标联合检测敏感度、特异度均优于单一指标检测。结论 超声心动图指标联合hs-cTnI、NT-proBNP有助于早期、全面判断新生儿脓毒症患者心功能情况，可用于评估预后，有一定的临床意义。 |
| 关键词: 新生儿 脓毒症 高敏心肌肌钙蛋白I N端B型脑钠肽前体 心功能 预后 |
| DOI：10.3969/j.issn.1674-3806.2020.10.19 |
| 分类号:R 722.1 |
| 基金项目: |
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| Early value of echocardiography combined with hs-cTnI and NT-proBNP detections in evaluating cardiac function and prognosis of neonates with sepsis |
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YANG Ning, MA Jin-xia, LIU Shu-yuan
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Department of Pediatrics, Dezhou People′s Hospital, Shandong 253000, China
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| Abstract: |
| ［Abstract］ Objective To investigate the value of echocardiography combined with high-sensitivity cardiac troponin I(hs-cTnI) and N-terminal pro-brain natriuretic peptide(NT-proBNP) detections in evaluation of cardiac function and early prediction of prognosis in neonates with sepsis. Methods Eighty-five cases of neonatal sepsis hospitalized in the Neonatal Intensive Care Unit of Dezhou People′s Hospital from December 2016 to December 2019 were selected. They were divided into cardiac dysfunction group(41 cases) and normal cardiac function group(44 cases) according to whether cardiac systolic function was dysfunctional or not during hospitalization. The cardiac dysfunction group was divided into death group(15 cases) and survival group(26 cases) according to whether they were alive or not within 28 days after admission. The levels of peripheral blood hs-cTnI, NT-proBNP, echocardiographic indexes induding cardiac output(CO), and ratio of early diastolic peak(E) to late diastolic peak(A)(E/A) were observed in each group within 24 hours after the patients were admitted to the hospital and were diagnosed with sepsis, and the value of each index in judging cardiac function and predicting prognosis of the sepsis neonates were evaluated. Results The levels of hs-cTnI and NT-proBNP in the cardiac dysfunction group were significantly higher than those in the normal cardiac function group, while the levels of CO and E/A in the cardiac dysfunction group were significantly lower than those in the normal cardiac function group(P<0.05). The levels of hs-cTnI and NT-proBNP in the death group were significantly higher than those in the survival group, and the levels of CO and E/A in the death group were significantly lower than those in the survival group(P<0.05). The levels of serum hs-cTnI and NT-proBNP were negatively correlated with CO and E/A of echocardiography in the sepsis neonates(P<0.05). Receiver operating characteristics(ROC) curve analysis showed that the area under curves(AUCs) of hs-cTnI, NT-proBNP, CO, E/A and the combination of the four indexes in evaluating the prognosis of the sepsis neonates were 0.854, 0.827, 0.769,0.738 and 0.902, respectively, which had high predictive value. The sensitivity and specificity of the combined detection of the four indexes were better than those of the single detection. Conclusion Echocardiographic indexes combined with detections of hs-cTnI and NT-proBNP are helpful for early and comprehensive evaluation of cardiac function in sepsis neonates, and can be used to evaluate their prognoses, which has certain clinical significance. |
| Key words: Neonates Sepsis High-sensitivity cardiac troponin I(hs-cTnI) N-terminal pro-brain natriuretic peptide(NT-proBNP) Cardiac function Prognosis |
