摘要
目的制定早期早产儿血浆N末端脑钠肽（NT-proBNP）参考值范围。方法1．研究对象按下列标准纳入：（1）2009年10月至2012年8月出生后24h内入住郑州大学第一附属医院新生儿病房的早产儿；（2）母亲孕期健康；（3）家属签署知情同意书者；（4）出生当天血气分析、电解质、肝肾功能、心肌酶、血常规及传染病4项（乙肝、丙肝、梅毒及艾滋病）等实验室辅助检查无异常者。2．用电化学发光免疫法于出生后1d、3d、7d检测血浆NT-proBNP水平。变量资料选用Shapiro—Wilk检验法进行正态性检验，呈正态分布者用面±s表示。不同时间点早产儿NT—proBNP水平比较采用重复测量资料的方差分析；NT—proBNP表达的影响因素分析采用多重线性回归模型，参考值区间：包含95％的参考总体的参考值范围。双侧正态（均数法）：i±1．96s。检验水准均为a=0．05。结果1．共入选因早产和（或）出生体质量较低要求寄养的早产儿204例。男104例，女100例；胎龄27^＋1-36^＋6周（中位数33周）；出生体质量700—3050g（中位数1590g）；阴道分娩78例，剖宫产126例；血清胆红素水平（56．6±23．1）p,mol／L；母亲年龄为（30．6±5．3）岁；不同性别之间各项参数差异无统计学意义（P〉0．05）。2．出生后1d血浆NT—proBNP水平作为因变量，将性别、分娩方式、胎龄、出生体质量、营养方式、血清胆红素及母亲年龄作为潜在的影响因素，行多重线性回归分析，Enter法全部强迫引入，结果显示，以n=0．05为检验水准，均与NT—proBNP水平无相关性。3．早产儿204例血浆NT—proBNP水平出生后1d、3d,7d数据经Shapiro-Wilk正态检验均呈正态分布。经重复测量资料的方差分析：不同日龄血浆NT—proBNP水平差异有统计学意义（F=443．824，P=0．000）；出生后1d最高，之后随出生后日龄增加而降低，二者呈负相关（r=一0．476，P=0．000）。不同日龄组间NT—proBNP水平两两比较，差异均有统计学意义（t1d目，d=4．358，t1d与7d=14．743，t3d与7d=11．105，P均=0．000）。出生后1d、3d、7d早产儿血浆NT—proBNP水平分别为（1875±686）ng／L、（1615±574）ng／L、（1118±380）ng／L；均数95％置信区间分别为530～3220ng／L、490—2740ns／L、373—1863ng／L。结论早产儿血浆NT—proBNP水平出生第1天达高峰，之后随日龄增加而下降，二者呈负相关；血浆NT-proBNP水平不受胎龄、性别、出生体质量、分娩方式及营养方式的影响。
Objective To establish the reference range of plasma N-terminal pro-brain natriuretic peptide （NT-proBNP） levels in early preterm infants. Methods 1. Inclusion criteria of the subjects： （ 1 ） preterm infants ad- mitted to Neonatal Ward of First Affiliated Hospital of Zhengzhou University between Oct. 2009 and Aug. 2012 within 24 hours after birth ; （ 2 ） maternal health during pregnancy; （ 3 ） written informed consent obtained from parents ; （ 4 ） normal laboratory examination results such as blood gas analysis, electrolyte, hepatorenal function, myocardial enzyme, routine blood count and infectious disease screening （hepatitis B, hepatitis C, syphilis and acquired immune deficiency syndrome） within 24 hours after birth. Plasma NT-proBNP levels were measured on day 1, day 3 and day 7 of life. Variable data was analyzed using the Shapiro-Wilk test for normality test. Difference in plasma NT-proBNP levels on different days of life was analyzed using repeated measure analysis of variance. A multiple regression analysis was per- formed to determine the influencing factors for plasma NT-proBNP level, reference value interval：reference range contai- ning 95 % of the reference population, namely （ $ - 1.96 s ） - （ $ ＋ 1.96 s ）, with inspection level a = 0.05. Results 1. A total of 204 preterm infants （104 cases were male and 100 cases were female） were included in the present study, with gestational age ranging from 27 ＋1 to 36.6 weeks（ median 33 weeks） and birth weight ranging from 700 to 3050 g （median 1590 g）. Of these preterm infants, vaginal delivery were 78 cases, cesarean delivery in 126 cases, serum biliru- bin level was （ 56.6 ＋ 23.1 ） p.mol/L, maternal age was （ 30.6 ＋ 5.3 ） years. There was no difference of these parame- ters between male and female （ P 〉 0.05 ）. 2. A multiple regression analysis was performed including following factors ： gender, delivery mode, gestational age, birth weight, alimentation mode, serum bilirubin, and maternal age, and none of the evaluated factors was independent influencing factor for plasma NT-proBNP level, with ot = 0.05 for inspection level. 3. Plasma NT-proBNP levels of the 204 preterm infants on day 1, day 3 and day 7 of life followed normal distribu- tion by Shapiro-Wilk test. By repeated measure analysis of variance, the NT-proBNP levels were significantly different on different days （ F = 443. 824, P = 0. 000 ）. NT-proBNP levels were highest on day 1 of life, and negatively correlated with age in days （ r = - 0. 476, P = 0. 000 ）. There was significant difference among groups according to different days after birth （ t1 d- 3 d = 4. 358, t1 d- 7 d = 14. 743, t3 d- 7 d = 11. 105, respectively; all P = 0. 000）. The levels on day 1, day 3 and day 7 of life were （ 1875 ＋ 686） ng/L, （ 1615 ＋ 574） ng/L and （ 1118 ＋ 380） ng/L, respectively, with 95% confi- dence interval 530 -3220 ng/L,490 -2740 ng/L and 373 - 1863 ng/L. Conclusions Plasma NT-proBNP levels of early preterm infants are highest on day 1 of life, and negatively correlated with age in days ; but not affected by gestational age, gender, birth weight, vaginal delivery or alimentation mode.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2013年第2期98-101,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
河南省医学科技攻关计划项目（201202003）
关键词
早期早产儿
血浆
N末端脑钠肽前体
参考值范围
Early preterm infants
Plasma
N-terminal pro-brain natriuretic peptide
Reference range
