摘要
目的探讨N端脑钠肽原（N—terminal pro—brain natriuretic peptide，NT-proBNP）判断重症手足口病患儿病情及预后的价值。方法回顾性分析2012年3月至2014年3月湖南省儿童医院重症监护病房收住的119例重症手足口病患儿资料。根据NT-proBNP水平，分为≤500pg／mL组（n=70）、〉500pg／mL组（n=49）；根据病情，分为重型（n=74），危重型（n=45，其中死亡27例，存活18例）。采用卡方检验、两样本t检验、秩和检验、Pearson或Spearman’s相关系数、受试者工作特征（ROC）曲线下面积（AUC）进行统计学分析。结果①NT-proBNP〉500pg／mL组入院时高热、呼吸异常、心率异常、收缩压异常、毛细血管充盈时间〉2s及实验室各指标高于NT-proBNP≤500pg／mL组（均P〈0．05）；且肺水肿、肺出血、病死率亦高于NT-proBNP≤500pg／mL组（均P〈0．05）。②危重型组NT-proBNP、血糖（BS）、白细胞（WBC）高于重型组（P均为0．00），而小儿危重病例评分（pediatric critical illness score，PCIS）低于重型组（t=14．70，P=0．00）；死亡患儿NT-proBNP高于存活患儿（X2=-2．60，P=0．01），而PCIS低于存活患儿（Z=2．70，P=0．01）；死亡与存活患儿BS、WBC差异无统计学意义（BS：t=-0．60，P=0．55；WBC：t=-0．72，P=0．48）。③NT-proBNP、BS、WBC与PCIS呈负相关（r分别为-0．58，0．46，-0．56，P均为0．00）；NT-proBNP、BS、WBC和PCIS判断病情严重程度的AUC分别为0．94、0．80、0．74、0．97，预测存亡的AUC分别为0．73、0．56、0．53、0．73。结论NT-proBNP升高提示心肺功能受累，是反映重症手足口病患儿病隋严重程度、预测28d生存情况的有效指标，且其价值优于BS、WBC。
Objective To explore the value of N-terminal pro-brain natriuretic peptide （NT- proBNP） in assessing severity and predicting prognosis in children with severe hand-foot-mouth disease （HFMD）. Methods A total of 119 eligible children with severe HFMD admitted in the pediatric intensive care unit were enrolled in this retrospective study from March 2012 to March 2014. According to NT-proBNP level, children were divided into ≤ 500 pg/mL group （n = 70） and 〉 500 pg/mL group （n = 49 ） ; whereas according to severity, children were divided into severe-type （n = 74） and critical-type （n = 45） ; and based on 28 days outcome in children with critical-type HFMD, children were divided into fatal group （n = 27） and survival group （n = 18）. The chi-square test, two-sample t test, rank sum test Pearson or Spearman＇ s correlation, area under the receiver operating characteristic curve （AUC） were used to analyze 119 children with severe hand-foot-mouth disease （HFMD）. Results Within 24 hours after admission, NT-proBNP 〉 500 pg / mL group had higher rates of fever, abnormal breathing, abnormal heart rate, abnormal systolic blood pressure, capillary refill time 〉 2 seconds and higher levels of laboratory biomarkers than NT-proBNP ≤ 500 pg/mL group （ P 〈 0. 05 ） ; and during hospitalization, the rates of pulmonary edema, pulmonary hemorrhage and death also higher than NT-proBNP ≤ 500 pg/mL group （ P 〈 0. 05 ）. NT-proBNP, BS, WBC were higher in critical-type group than severe-type group （P = 0. 00） , while the PCIS （ pediatric critical illness score ） was lower in critical-type group （ X2 = 14. 70, P = 0.00 ）. NT- proBNP was higher in fatal group than that in survival group （ t = - 2. 60, P = 0. 01 ）, PCIS was lower in fatal group （Z = 2. 70, P = 0. 01 ） ; and there were no statistically significant differences in BS and WBC between fatal and survival groups （BS： t = -0.60, P=0.55; WBC： t = -0.72, P=0.48）. NT- proBNP, BS and WBC were negativ
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2015年第6期602-607,共6页
Chinese Journal of Emergency Medicine
基金
国家科技支撑计划儿科应急救治相关技术的研究与推广应用项目（2012BAI04800）
关键词
N端脑钠肽原
重症
手足口病
心肺功能
小儿危重病评分
血糖
白细胞
预后
N-terminal pro-brain natriuretic peptide
Severe
Hand-foot-mouth disease
Cardiopulmonary function
Pediatric critical illness score
Blood sugar
White blood cell
Prognosis
