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目的探讨血浆生物学标志物氨基末端B型利钠肽前体(NT-proBNP)心力衰竭判断指标与改良Ross标准、青岛标准的符合率和相关性,并拟定适合我国国情的小儿心力衰竭联合诊断标准;探讨NT-proBNP在心源性与非心源性呼吸困难诊断的鉴别意义。方法测定2010年3月-2011年9月佛山市顺德区妇幼保健院收治的以改良Ross评分标准诊断的50例小儿心力衰竭患儿(心力衰竭组)、50例非心源性呼吸困难患儿(无心力衰竭组)及50例健康儿童(健康对照组)血浆NT-proBNP水平;并测定心力衰竭治疗后NT-proBNP水平;计算NT-proBNP心力衰竭判断指标与改良Ross标准及青岛标准的符合率;拟定心力衰竭联合诊断标准;确定血浆NT-proBNP在心源性与非心源性呼吸困难诊断的鉴别意义,并进行统计学分析。结果 50例心力衰竭患儿中48例NT-proBNP指标异常升高,心力衰竭NT-proBNP诊断指标与改良Ross心力衰竭诊断标准的符合率为96.0%;轻、中、重度心力衰竭患儿NT-proBNP水平与改良Ross标准有相关性(r=0.675,P=0.000);48例NT-proBNP异常升高的心力衰竭患儿中32例符合青岛心力衰竭诊断标准,符合率为66.67%;无心力衰竭组及健康对照组NT-proBNP检测无一例异常升高,心力衰竭组与无心力衰竭组、健康对照组比较差异有统计学意义(Pa=0.000)。50例心力衰竭患儿经抗心力衰竭治疗后38例NT-proBNP水平降至正常、12例明显下降;治疗前后NT-proBNP指标比较差异有统计学意义(P=0.001)。结论 NT-proBNP可作为心力衰竭诊断的敏感生物学指标物;改良Ross标准与NT-proBNP心力衰竭判断指标符合率高,二者结合可作为心力衰竭联合诊断标准;NT-proBNP检测有助于心源性与非心源性呼吸困难的鉴别诊断。
Objective To investigate the coincidence rate and correlation between the judgment index of plasma BN-BNP precursor (NT-proBNP) and the modified Ross standard and Qingdao standard and to develop a combined diagnosis of heart failure in children with China’s national conditions Standard; explore NT-proBNP in the differential diagnosis of cardiogenic and noncardiogenic dyspnea. Methods From March 2010 to September 2011, 50 children with heart failure (heart failure group) and 50 children with non-cardiac dyspnea who were diagnosed as modified Ross score were enrolled in Foshan Maternal and Child Health Hospital. (Without heart failure group) and 50 healthy children (healthy control group). NT-proBNP level was measured after heart failure treatment. The calculated indexes of NT-proBNP heart failure were in accordance with the modified Ross standard and Qingdao standard Rate; the development of joint diagnosis of heart failure criteria; to determine the significance of plasma NT-proBNP in the diagnosis of cardiogenic and non-cardiac dyspnea, and statistical analysis. Results 48 cases of NT-proBNP abnormalities in 50 cases of children with heart failure were abnormally elevated. The coincidence rate of NT-proBNP diagnostic criteria of heart failure and modified Ross heart failure diagnostic criteria was 96.0%. NT- (r = 0.675, P = 0.000); 48 cases of heart failure patients with abnormally elevated NT-proBNP in 32 cases meet the diagnostic criteria of Qingdao heart failure, with a coincidence rate of 66.67%; no cardiac stress No abnormality of NT-proBNP was detected in the failure group and the healthy control group. The difference between the heart failure group and the non-heart failure group and the healthy control group was statistically significant (Pa = 0.000). Thirty-eight cases of NT-proBNP decreased to normal after treatment in 50 children with heart failure. The levels of NT-proBNP in 12 children were significantly decreased. The difference of NT-proBNP before and after treatment was statistically significant (P = 0.001). Conclusion NT-proBNP can be used as a sensitive biological indicator of heart failure diagnosis; improved Ross standard and NT-proBNP heart failure to determine indicators in line with the high rate of combination of the two can be used as a combined diagnosis of heart failure; NT-proBNP test can help heart Differential Diagnosis of Dyspnea and Noncardiac Dyspnea.