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中华诊断学电子杂志

中华诊断学电子杂志 ›› 2020, Vol. 08 ›› Issue (01) : 57 -61. doi: 10.3877/cma.j.issn.2095-655X.2020.01.013

所属专题： 文献；

临床研究

B型尿钠肽对新生儿胎粪吸入综合征合并持续性肺动脉高压的诊断价值
田玉红1,†(), 常艳华1, 王瑜1   
  1. 1. 272029　济宁医学院附属医院儿科
  • 收稿日期:2019-06-13 出版日期:2020-02-26
  • 通信作者: 田玉红

The predictive value of B-type natriuretic peptide to meconium aspiration syndrome with persistent pulmonary hypertension of the newborn

Yuhong Tian1,†(), Yanhua Chang1, Yu Wang1   

  1. 1. Department of Newborn Care Unit, the Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2019-06-13 Published:2020-02-26
  • Corresponding author: Yuhong Tian
  • About author:
    Corresponding author: Tian Yuhong, Email:
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田玉红, 常艳华, 王瑜. B型尿钠肽对新生儿胎粪吸入综合征合并持续性肺动脉高压的诊断价值[J]. 中华诊断学电子杂志, 2020, 08(01): 57-61.

Yuhong Tian, Yanhua Chang, Yu Wang. The predictive value of B-type natriuretic peptide to meconium aspiration syndrome with persistent pulmonary hypertension of the newborn[J]. Chinese Journal of Diagnostics(Electronic Edition), 2020, 08(01): 57-61.

目的

探讨新生儿胎粪吸入综合征(MAS)患儿血浆B型尿钠肽(BNP)水平对持续性肺动脉高压(PPHN)的诊断价值。

方法

本研究采用前瞻式队列研究，选择2017年1月至2019年3月在济宁医学院附属医院新生儿监护病房(NICU)住院新生儿86例，把符合MAS诊断的新生儿分为合并PPHN组(n＝26)和非PPHN组(n＝60)，所有MAS患儿在出生后24～48 h第1次采血检测血浆BNP水平并收集相关围产期资料，所有MAS患儿在病情加重时均再次采血，检测血浆BNP水平并完善血气分析、胸片、超声心动图检查，比较PPHN组与非PPHN组间BNP水平、氧合指数(OI)、肺泡-动脉氧分压(A-aDO2)差异，采用ROC曲线分析BNP水平对PPHN预测的诊断效能及诊断敏感度、特异度。

结果

PPHN组患儿出生后24～48 h血浆BNP水平[1 049.87(787.95，1 484.50)ng/L]高于非PPHN组[344.15(302.75，510.25)ng/L]，差异有显著意义(U＝68.50，P<0.01)。PPHN组患儿在病情加重时BNP水平[1 435.45(986.50，1 869.20)ng/L]、A-aDO2[(535.72±82.13)mmHg]明显高于非PPHN组病情加重患儿[632.54(479.35，867.23)ng/L，(388.75±78.78)mmHg](U＝57.75，t＝5.83；均P<0.01)，而两组间OI(20.38±3.88，21.62±4.86)比较，差异无统计学意义(t＝0.86，P>0.05)。ROC曲线分析BNP水平对MAS合并PPHN的诊断效能，曲线下面积0.956(95%CI：0.889～0.989)，血浆BNP水平最佳阈值>652 ng/L，敏感度88.46%，特异度95.00%。

结论

MAS新生儿血浆BNP水平的升高可提示PPHN的发生，其评估PPHN的特异度、敏感度均较高，可作为早期诊断的生物学指标。

关键词: B型尿钠肽, 新生儿持续性肺动脉高压, 新生儿胎粪吸入综合征
Objective

To investigate the predictive value of serum B-type natriuretic peptide (BNP) to meconium aspiration syndrome (MAS) with persistent pulmonary hypertension of the newborn (PPHN).

Methods

It was a prospective cohort study, 86 infants were enrolled in the NICU from January 2017 to March 2019. Infants of MAS were classified into the PPHN group (n=26) and non-PPHN group (n=60), all infants were collected data in perinatal period. Serum BNP levels were detected in the 24-48 hours after birth. When the condition of the MAS infants was aggravated, serum BNP levels, blood gas analysis, chest X-ray and echocardiography were detected. BNP levels and OI, A-aDO2 were compared between PPHN group and non-PPHN group.

Results

BNP levels in PPHN group [1 049.87(787.95, 1 484.50)ng/L] were significantly different with those in non-PPHN group [344.15(302.75, 510.25)ng/L] in the 24-48 hours after birth(U=68.50, P<0.01). In the infants with PPHN, significantly higher increases were found in BNP levels [1 435.45(986.50, 1 869.20)ng/L] and A-aDO2 [(535.72±82.128)mmHg] compared with those in non-PPHN group [632.54(479.35, 867.23)ng/L, (388.75±78.78)mmHg] when the condition was aggravated (U=57.75, t=5.83, all P<0.01). But there was no significant difference in OI (20.38±3.88, 21.62±4.86) between the two groups (t=0.86, P>0.05). ROC curve was used to analyze the diagnostic efficacy of BNP level for PPHN combined with MAS. The area under the curve was 0.956 (95%CI: 0.889~0.989). The optimum threshold BNP level was 652 ng/L, the sensitivity of predicting PPHN was 88.46%, and the specificity was 95.00%.

Conclusion

In the MAS infant, BNP had excellent sensitivity and specificity in predicting PPHN, which maybe a useful early diagnosis biomarker.

Key words: B-type natriuretic peptide, Persistent pulmonary hypertension of the newborn, Meconium aspiration syndrome
表1 PPHN组与非PPHN组患儿一般临床特征比较
项目 非PPHN组(n＝60) PPHN组(n＝26) 统计量 P值
出生体重(g，±s) 3 331.25±437.06 3 400.00±497.02 t＝0.28 0.78
胎龄(周，±s) 39.11±1.38 38.98±1.08 t＝－0.38 0.71
母亲年龄(岁，±s) 29.94±6.97 28.56±6.73 t＝－0.93 0.36
性别(例，%) χ2＝0.09 0.76
男 39(65.00) 16(61.54)
女 21(35.00) 10(38.46)
分娩方式(例，%) χ2＝0.01 0.93
顺产 19(31.67) 8(30.77)
剖宫产 41(68.33) 18(69.23)
窒息(例，%) χ2＝1.79 0.00
无窒息 29(48.33) 3(11.54)
轻度窒息 25(41.67) 11(42.31)
重度窒息 6(10.00) 12(46.15)
宫内感染(例，%) χ2＝2.18 0.14
否 50(83.33) 18(69.23)
是 10(16.67) 8(30.77)
机械通气(例，%) χ2＝32.41 0.00
否 40(66.67) 0(0.00)
是 20(33.33) 26(100.00)
死亡(例，%) χ2＝4.16 0.03
否 60(100.00) 23(88.46)
是 0(0.00) 3(11.54)
表2 PPHN组与非PPHN组(A)血浆BNP水平与通气参数比较
项目 非PPHN组(A)(n＝15) PPHN组(n＝26) 统计量 P值
BNP(ng/L，[M(Q1，Q3)]) 632.54(479.35，867.23) 1 435(986.50，1 869.20) U＝57.75 0.00
A-aDO2(mmHg，±s) 388.75±78.78 535.72±82.13 t＝5.83 0.00
OI(±s) 20.38±3.88 21.62±4.86 t＝0.86 0.39
图1 血浆BNP水平预测MAS合并PPHN的ROC曲线
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