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≤500 pg/mL组(n=70)、＞500 pg/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＞ 500 pg/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≤500 pg/mL组(均P＜0.05);且肺水肿、肺出血、病死率亦高于NT-proBNP≤500 pg/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-0.58,58.46,-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.

abstractsObjective 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).NTproBNP 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 negatively correlated with PCIS (r values were-0.58,-0.46,-0.56,P values were 0.00).The AUCs of NT-proBNP,BS,WBC and PCIS to determine the severity of severe HFMD children were 0.94,0.80,0.74,and 0.97,respectively; and to predict 28 days survival in criticaltype HFMD were 0.73,0.56,0.53,and 0.73,respectively.Conclusions Higher level of NT-proBNP could prompt cardiopulmonary involvement.NT-proBNP could reflect the severity of illness and served as a sensitive marker in predicting 28-day survival,being better than BS and WBC.