有血流动力学意义的动脉导管未闭早产儿血浆脑钠肽水平变化及其与血流动力学的关系

doi:10.13481/j.1671-587x.20190126

摘要/Abstract

摘要： 目的：探讨有血流动力学意义的动脉导管未闭（hsPDA）早产儿血浆脑钠肽（BNP）水平变化及其与血流动力学的关系，进一步阐明BNP在hsPDA早产儿病情判断和治疗中的临床意义。方法：出生6 h内且胎龄 ≤ 32周的早产儿106例，分为hsPDA组（43例）、无血流动力学意义的动脉导管未闭组（nhsPDA组，27例）和非动脉导管未闭组（nPDA组，36例）。hsPDA组患儿根据是否服用布洛芬分为hsPDA治疗组（33例）和hsPDA非治疗组（10例），hsPDA治疗组患儿给予布洛芬口服治疗后第7天复查超声心动图，并根据超声心动图结果将hsPDA治疗组分为hsPDA关闭组（15例）和hsPDA未闭组（18例）。各组早产儿出生后第1、3和7天行超声心动图检查，记录左心房（LA）/主动脉根部内径（VO）值、动脉导管直径、左室射血分数（LVEF）、短轴缩短率、左室舒张末期内径（LVEDD）和左室收缩末期内径（LVESD），采用电化学发光法测定血浆BNP水平。对超声心动图血流动力学指标和血浆BNP水平进行相关性分析。结果：与nhsPDA组比较，hsPDA组早产儿LA/VO值、动脉导管直径和LVEDD均明显升高（P<0.05）；hsPDA关闭组和未闭组早产儿出生后1和3 d血浆BNP水平明显高于nPDA组（P<0.05）；hsPDA关闭组早产儿出生后第7天血浆BNP水平明显低于出生后第3天（P<0.05）。与hsPDA非治疗组比较，hsPDA治疗组早产儿第7天LA/VO值、动脉导管直径、LVEDD和BNP水平均明显降低（P<0.05）。出生后3 d hsPDA组早产儿血浆BNP水平与LA/VO值和动脉导管直径呈正相关关系（r=0.727，P<0.05；r=0.780，P<0.05）。结论：早产儿出生第3天后血浆BNP水平与血流动力学指标呈正相关关系，检测其水平变化有助于判断hsPDA早产儿病情，为诊断提供依据。

关键词: 血流动力学, 动脉导管未闭, 早产儿, 脑钠肽

Abstract: Objective: To explore the change in the cerebral natriuretic peptide (BNP) levels in the premature infants with hemodynamically significant patent dectus arteriosus (hsPDA) and its relationship with hemodynamics, and to further clarify the clinical significance of BNP in the judgement of illness condition and treatment in the premature infants with hsPDA.Methods: A total of 106 cases of premature infants within 6 h of birth whose gestational age was no more than 32 weeks were selected and divided into hsPDA group (43 cases) and PDA with no hemodynamic significance group (nhsPDA group, 27 cases) and no PDA group (nPDA group, 36 cases).The patients in HsPDA group were divided into hsPDA treatment group(33 cases) and hsPDA non-treatment group(10 cases) according to whether ibuprofen was administrated or not. Echocardiography was performed in the patients in hsPDA treatment group,7 d after oral ibuprofen administration, and the patients in hsPDA treatment group were divided into hsPDA close group(15 cases) and hsPDA non-close group(18cases). The left atrium (LA)/aortic root diameter (VO) value, diameter of patent arterial duct, left ventricular ejection fraction(LVEF), shortening fraction, left ventricular end-diastolic diameter(LVEDD) and left ventricular end-systolic diameter(LVESD) were recorded at 1, 3, 7 d after birth of the premature infants in various groups with echocardiography.The level of BNP in plasma was determined by electrochemiluminescence. The correlation analysis was performed between the hemodynamic indexes of echocardiography and the level of BNP in plasma.Results: Compared with nhsPDA group, the LA/VO value, arterial catheter diameter and LVEDD were significantly increased (P<0.05).The plasma BNP levels of premature infants in hsPDA close and non-close groups at 1 and 3 d after birth were significantly higher than those in nPDA group (P<0.05); the plasma BNP level of the premature infants in hsPDA close group at 7 d after birth was significantly lower than that at 3 d after birth (P<0.05).Compared with hsPDA non-treatment group, the LA/VO value, arterial catheter diameter,LEVDD and the plasma BNP level of the premature infants in hsPDA treatment group at 7 d after birth were significantly decreased (P<0.05). The plasma BNP level was positively correlated with the LA/VO value and arterial catheter diameter (r=0.727,P<0.05;r=0.780, P<0.05) of the premature infants in hsPDA group at 3 d after birth.Conclusion: The level of plasma BNP of premature infants 3 d after birth is positively correlated with the hemodynamic indexes, and the detection of the changes of the plasma BNP levels is helpful to judge the condition of preterm infants with hsPDA and to provide basis for its diagnosis.

Key words: hemodynamics, patent ductus arteriosus, premature infant, brain natriuretic peptide

中图分类号:

R543.5

姚芒, 黄慧洁, 刘丽娜, 封丽娟. 有血流动力学意义的动脉导管未闭早产儿血浆脑钠肽水平变化及其与血流动力学的关系[J]. 吉林大学学报(医学版), 2019, 45(01): 143-147.

YAO Mang, HUANG Huijie, LIU Lina, FENG Lijuan. Change in plasma brain natriuretic peptide level in premature infants with hemodynamically signficant patent ductus arteriosus and its relationship with hemodynamics[J]. Journal of Jilin University(Medicine Edition), 2019, 45(01): 143-147.

参考文献

[1] 董慧茹,何少茹,郑曼利,等. 不同胎龄新生儿动脉导管自然闭合时间及心脏指数、外周血管阻力、血压的动态变化[J]. 中华实用儿科临床杂志,2015,30(14):1060-1063.
[2] 毛璇,李宇宁. 对乙酰氨基酚治疗早产儿动脉导管未闭的应用进展[J]. 临床合理用药杂志,2017,10(19):180-181.
[3] POLAT T B,CELIK I H,ERDEVE O. Early predictive echocardiographic features of hemodynamically significant patent ductus arteriosus in preterm VLBW infants[J]. Pediatr Int, 2016, 58(7):589-594.
[4] 高翔羽,任漪,黑明燕,等. B型尿钠肽在早期早产儿有血流动力学意义的动脉导管未闭中的诊治价值[J]. 中华实用儿科临床杂志,2016,31(14):1072-1075.
[5] SANJEEV S,PETTERSEN M,LUA J, et al. Role of plasma B-type natriuretic peptide in screening for hemodynamically significant patent ductus arteriosus in preterm neonates.[J]. J Perinatol, 2005, 25(11):709-713.
[6] MINE K,OHASHI A,TSUJI S, et al. B-type natriuretic peptide for assessment of haemodynamically significant patent ductus arteriosus in premature infants[J]. Acta Paediatr, 2013, 102(8):e347-e352.
[7] KHOSROSHAHI A J,KIANFAR A,AHARANJANI B M, et al. Usefulness of serum brain natriuretic peptide level for screening hemodynamically significant patent ductus arteriosus in preterm neonates[J]. Iranian J Pediatr, 2014, 24(6):766-769.
[8] LU D, LIU Y, TONG X. Clinical characteristics and cardiac hemodynamic changes of patent ductus ateriosus in preterm infants[J]. Chin J Pediatr, 2015, 53(3):187-193.
[9] 吴本清,闫玉琴,汪青. 新生儿动脉导管关闭时间及其对心功能的影响[J]. 中华全科医学,2011,9(4):625-626.
[10] 陈佳,封志纯. 早产儿动脉导管未闭的发病机制、高危因素及并发症[J]. 中国新生儿科杂志,2013,28(1):62-65.
[11] 郑曼利,何少茹,刘玉梅,等. 具有血流动力学影响的动脉导管对极低出生体重儿的血流动力学影响[J]. 发育医学电子杂志,2014,2(2):81-86.
[12] 罗佳媛. 布洛芬治疗早产儿hsPDA的疗效判断及影响因素分析[D].乌鲁木齐:新疆医科大学,2018.
[13] 陈笑征,杜忠东. 早产儿动脉导管未闭的诊断及治疗[J]. 中国医刊,2018,53(04):365-369.
[14] SUDOH T,KANGAWA K,MINAMINO N, et al. A new natriuretic peptide in porcine brain[J]. Nature, 1988, 332(6159):78-81.
[15] 李晶晶,张辉,魏丹,等. 脑钠肽和氨基末端脑钠肽前体在小儿先天性心脏病体外循环手术围术期诊断和预后判断的意义[J]. 北京医学,2017,39(7):718-720.
[16] 周建文,陈燕新,钱大钧. 慢性心力衰竭患者血浆BNP水平与左室功能的相关性探究[J]. 中华全科医学,2015,13(11):1896-1898.
[17] DJER M M,SASTROASMORO S,MADIYONO B. Heart size, heart function, and plasma B-type natriuretic peptide levels after transcatheter closure of patent ductus arteriosus[J]. Paediatr Indonesiana, 2013, 53(3):181-186.
[18] 周雅娟,纪凤娟,徐娟,等. 脑钠肽及N端脑钠肽在先天性心脏病患儿中的应用价值[J]. 医学综述,2018,24(3):459-464.
[19] FAROMBI-OGHUVBU I,MATTHEWS T,MAYNE P D,et al. N-terminal-pro-B type natriuretic peptide:a measure of significant patent ductus arteriosus[J]. Arch Dis Child Fetal Neonatal Ed,2008, 93(4):F257-F260.
[20] 李智. NT-proBNP联合BNP在心血管疾病患儿诊断与评估中的价值分析[J]. 国际检验医学杂志,2018,39(8):1007-1009,1024.
[21] 余增渊,孙慧清,李明超,等. B型脑钠肽与早产儿支气管肺发育不良的相关性分析[J]. 临床肺科杂志,2018,23(6):1052-1057.