2022 年第 10 期 第 17 卷

血清N末端B型脑钠肽前体对新生儿窒息所致脑损伤的预测价值

Predictive value of serum N-terminal pro-brain natriuretic peptide in brain injury caused by neonatal asphyxia

作者：贾延贞1常璠2纪荣祖2李海萍1杨晶1尕项卓玛3王晶1杨成英1刘福星2何兵2高延可2

英文作者：Jia Yanzhen1 Chang Fan2 Ji Rongzu2 Li Haiping1 Yang Jing1 Gaxiangzhuoma3 Wang Jing1 Yang Chengying1 Liu Fuxing2 He Bing2 Gao Yanke2

单位：1青海省西宁市第三人民医院儿科，西宁810005；2青海省西宁市第三人民医院检验科，西宁810005；3青海省西宁市第三人民医院产科，西宁810005

英文单位：1Department of Pediatrics the Third People′s Hospital of Xining Qinghai Province Xining 810005 China; 2Department of Laboratory the Third People′s Hospital of Xining Qinghai Province Xining 810005 China; 3Department of Obstetrics the Third People′s Hospital of Xining Qinghai Province Xining 810005 China

关键词：N末端B型脑钠肽前体；新生儿窒息；脑损伤；头颅CT

英文关键词：N-terminalpro-brainnatriureticpeptide;Neonatalasphyxia;Braininjury;CranialCT

• 摘要：

• 目的 探讨血清N末端B型脑钠肽前体（NT-proBNP）对新生儿窒息所致脑损伤的预测价值。方法 选取2018年6月至2021年4月于青海省西宁市第三人民医院妇产科新生儿重症监护室进行住院治疗的足月窒息新生儿189例，收集患儿临床资料进行回顾性分析。将患儿根据窒息程度分为轻度窒息组(129例)和重度窒息组(60例)。选取同期青海省西宁市第三人民医院妇产科健康的足月生产新生儿75例为对照组。窒息新生儿于出生第7天行头颅CT检查，依据头颅CT检查结果分为头颅CT阳性与头颅CT阴性。比较各组新生儿出生后1、7、14 d血清NT-proBNP水平变化。采用受试者工作特征（ROC）曲线评估血清NT-proBNP对窒息新生儿脑损伤（头颅CT阳性）的预测能力。结果 出生后1、7、14 d，重度窒息组和轻度窒息组的血清NT-proBNP水平均高于对照组，差异均有统计学意义（均P＜0.05）。重度窒息组头颅CT阳性率高于轻度窒息组［85.0%(51/60)比46.5%（60/129）］，差异有统计学意义（χ2=25.029，P＜0.001）。头颅CT阳性新生儿出生后1、7、14 d的血清NT-proBNP水平均高于头颅CT阴性新生儿，差异均有统计学意义（均P＜0.05）。出生后1、7、14 d的血清NT-proBNP水平预测头颅CT阳性的曲线下面积分别为0.821(95%置信区间：0.731～0.911)，0.799(95%置信区间：0.706～0.892)及0.634(95%置信区间：0.529～0.739)，其中出生后1 d时的血清NT-proBNP水平预测能力最强。结论 窒息新生儿血清NT-proBNP水平明显升高，其动态变化对新生儿窒息所致脑损伤有一定的预测价值。

• Objective  To investigate the predictive value of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level in brain injury caused by neonatal asphyxia. Methods Totally 189 full-term asphyxiated newborns in Neonatal Intensive Care Unit of Obstetrics and Gynecology, the Third People′s Hospital of Xining, Qinghai Province from June 2018 to April 2021 were retrospectively selected. According to the degree of asphyxia, the newborns were divided into mild asphyxia group (129 cases) and severe asphyxia group (60 cases). Another 75 full-term healthy newborns in the hospital were selected as the control group. Newborns with asphyxia underwent cranial CT examination on the 7th day of life. According to the Results of cranial CT examination, they were divided into cranial CT positive group and cranial CT negative group. The changes of serum NT-proBNP levels 1, 7 and 14 d after birth were compared. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of serum NT-proBNP in brain injury (cranial CT positive) in asphyxiated newborns. Results On 1, 7 and 14 d after birth, the serum NT-proBNP level in severe asphyxia group and mild asphyxia group was significantly higher than that in control group (all P＜0.05). The positive rate of cranial CT in severe asphyxia group was higher than that in mild asphyxia group ［85.0%(51/60) vs 46.5%(60/129)］（χ2=25.029，P＜0.001）. The serum NT-proBNP level of newborns with positive cranial CT was significantly higher than that of newborns with negative cranial CT 1, 7 and 14 d after birth (all P＜0.05). The areas under the curve of serum NT-proBNP level 1, 7 and 14 d after birth were 0.821 (95% confidence interval: 0.731-0.911), 0.799 (95% confidence interval: 0.706-0.892) and 0.634 (95% confidence interval: 0.529-0.739), respectively. The prediction ability of serum NT-proBNP level 1 d after birth was the strongest. Conclusion The level of serum NT-proBNP in asphyxiated newborns increases significantly, and its dynamic changes have monitoring and early warning value for brain injury caused by neonatal asphyxia.