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Objective To analyze clinical prognosis, risk factors and predictive indexes of hyperkalemia in recipients after heart transplantation. Methods Clinical data of 158 recipients were retrospectively analyzed. According to the serum potassium levels within postoperative 1-year follow-up, all recipients were divided into the normal serum potassium level group (n=83), hyperkalemia group (n=43) and severe hyperkalemia group (n=32). The incidence and prognosis of hyperkalemia after heart transplantation were summarized. The risk factors and predictive indexes of hyperkalemia after heart transplantation were identified. Results The incidence of hyperkalemia and severe hyperkalemia within postoperative 1 year was 47.5%(75/158) and 20.3%(32/158), respectively. In the severe hyperkalemia group, the fatality was 16%(5/32), higher than 8%(7/83) in the normal serum potassium level group and 7%(3/43) in the hyperkalemia group. The mean serum creatinine (Scr) within 6 months before heart transplantation, the final total bilirubin level before heart transplantation, postoperative hemodialysis time, the Scr level and N-terminal pro-brain natriuretic peptide level at postoperative 1 d were the independent risk factors for hyperkalemia following heart transplantation (all P < 0.05). The mean Scr level within 6 months before heart transplantation, postoperative hemodialysis time, and Scr levels at postoperative 1 and 7 d could be used to predict postoperative severe hyperkalemia. Conclusions The recipients with severe hyperkalemia after heart transplantation obtain poor prognosis. The mean Scr level within 6 months before heart transplantation, the final total bilirubin level before heart transplantation, postoperative hemodialysis time, and the Scr level and N-terminal pro-brain natriuretic peptide level at postoperative 1 d are the independent risk factors for hyperkalemia after heart transplantation. Perioperative Scr level and postoperative hemodialysis time may be used to predict the incidence of severe hyperkalemia within 1 year after heart transplantation.
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Objective To evaluate the effect of donor age on short-term survival of patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. Methods Clinical data of 235 IPF donors and recipients of lung transplantation were retrospectively analyzed. Univariate and multivariate Cox proportional hazard regression models were employed to analyze the correlation between donor age and short-term mortality rate of IPF patients after lung transplantation. Kaplan-Meier was used to draw the survival curve. Results Univariate Cox regression analysis showed that donor age was correlated with the 1-year fatality of IPF patients after lung transplantation. The 1-year fatality of recipients after lung transplantation was increased by 0.020 times if donor age was increased by 1 year (P=0.009). Oxygenation index of the donors, preoperative oxygenation index, preoperative lung allocation score, preoperative N-terminal pro brain natriuretic peptide, pattern of transplantation, pattern of intraoperative extracorporeal membrane oxygenation and intraoperative blood transfusion volume of the recipients were correlated with 1-year fatality after lung transplantation (all P < 0.1). Multivariate Cox regression analysis demonstrated that there was no correlation between donor age and 30-, 90-, 180-d and 1-year fatality of IPF patients after lung transplantation (all P > 0.05). Sensitivity analysis showed that there was no significant difference in 30-, 90-, 180-d and 1-year fatality after lung transplantation among donors aged < 18, 18-33, 34-49 and ≥50 years (all P > 0.05). Conclusions Donor age exerts no effect upon short-term survival of IPF patients after lung transplantation. Considering the mechanical ventilation time, oxygenation index, infection and other factors of donors, the age range of lung transplant donors may be expanded.
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Objective:To investigate the efficacy and safety of cedilanid in the treatment of severe pneumonia in infants and the value of preventing heart failure.Methods:A total of 80 children with severe pneumonia admitted to Dezhou Maternal and Child Health Hospital from January 2019 to December 2020 were selected and randomly divided into the control group and the observation group, with 40 cases in each group. The control group received comprehensive treatment, while the observation group was treated with cedilanid (0.01 mg/kg, one-time intravenous injection) on the basis of the control group. The efficacy of both groups was observed after 5 d of treatment. The incidence of heart failure, correction time of heart failure, improvement time of symptoms and signs, and length of hospitalization time were compared between the two groups; the inflammatory markers, myocardial markers and arterial blood gas indexes were compared between the two groups before and after the treatment.Results:The total effective rate in the observation group was higher than that in the control group, and the incidence of heart failure in the observation group was lower than that in the control group: 90.0% (36/40) vs. 72.5% (29/40), 32.5%(13/40) vs. 10.0%(4/40), the differences were statistically significant ( χ2 = 4.02, 4.10, P<0.05). The improvement time of symptoms and signs (restlessness elimination, respiratory improvement, heart rate improvement and disappearance of rhonchus in lung) in the observation group were less than those in the control group ( P<0.05). The levels of procalcitonin (PCT) and N-terminal pro-brain natriuretic peptide (NT-ProBNP), myocardial troponin I(cTnI), and creatine kinase isoenzyme (CK-MB) in the observation group after treatment were lower than those in the control group: (6.15 ± 1.03) μg/L vs. (10.85 ± 2.12) μg/L, (112.02 ± 30.09) ng/L vs. (215.39 ± 55.08) ng/L, (0.68 ± 0.17) μg/L vs. (1.12 ± 0.34) μg/L, (19.05 ± 6.11) U/L vs. (28.97 ± 7.82) U/L, P<0.05. The levels of oxygen partial pressure (PaO 2), blood oxygen saturation (SaO 2) and oxygenation index (PaO 2/FiO 2) in the observation group after treatment were higher than those in the control group: (6.15 ± 1.03) μg/L vs. (10.85 ± 2.12) μg/L, (112.02 ± 30.09) ng/L vs. (215.39 ± 55.08) ng/L, (0.68 ± 0.17) μg/L vs. (1.12 ± 0.34) μg/L, (19.05 ± 6.11) U/L vs. (28.97 ± 7.82) U/L, P<0.05. Conclusions:Early application of small dose of cedilanid in infants with severe pneumonia can effectively reduce the occurrence of heart failure, improve the clinical symptoms and blood gas indicators, with significant curative effect, which is worthy of promotion.
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Objective:To investigate the diagnostic and early-warning value of laboratory test indicators for sepsis-induced myocardial injury (SIMD).Methods:The clinical data of 183 patients with sepsis admitted to the Department of Emergency and Critical Care Medicine of Guangdong Provincial People's Hospital from August 2016 to October 2020 were collected. The patient's age, gender, past medical history, vital signs and pathogen culture results were extracted. Cardiac function, blood routine, liver function, renal function, inflammatory factors, coagulation function, APACHE Ⅱ and SOFA scores were recorded at enrollment and 72 h after admission. SIMD was defined as cTnT ≥300 pg/mL and NT-proBNP ≥1243 pg/mL twice in 72 h intervals between enrolled cases, and the early-warning factors of patients with SIMD were analyzed. The differences in various indicators between the two groups were compared, and Logistic regression analysis was used to explore the diagnostic efficacy of cTnT and NT-proBNP combined for SIMD, and the correlation between PCT/PLT ratio and the occurrence of SIMD.Results:Among 250 patients, 67 patients were excluded for lack of the main indicators, and 183 patients (including 62 patients with history of cardiac disease) were enrolled finally. Among 183 patients with sepsis, 105 patients (57.38%) with cTNT ≥300 pg/mL and NT-proBNP ≥1 243 pg/mL, were diagnosed as myocardial injury; after excluding 62 patients with history of cardiac disease, 59 patients (48.76%) with cTNT ≥300 pg/mL and NT-proBNP ≥1 243 pg/mL were diagnosed as myocardial injury. Logistic regression analysis showed that increased PCT/PLT ratio ( OR=1.585, 95% CI: 1.124-2.237, P=0.009) was an independent risk factor for early-warning of SIMD. The PCT/PLT ratio ( OR= 1.850, 95% CI: 1.103-3.102, P=0.020) could stably predict the occurrence of SIMD in patients without previous history of heart disease. ROC curve analysis showed that PCT/PLT ratio could effectively predict the occurrence of SIMD (AUC=0.693, 95% CI: 0.617-0.769, P<0.001), the optimal cut-off value was 0.177 (sensitivity: 65.7%, specificity: 66.7%). The PCT/PLT ratio was still effective in predicting the occurrence of SIMD after excluding patients with previous history of heart disease (AUC=0.733, 95% CI: 0.643-0.823, P<0.001), and the optimal cut-off value was 0.429 (sensitivity: 55.9%, specificity: 83.9%). Conclusions:The combination of cTnT and NT-proBNP has certain diagnostic value for SIMD, and the PCT/PLT ratio could warn the occurrence of SIMD.
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Objective To summarize the experience of diagnosis and treatment of Takotsubo syndrome (TTS) after liver transplantation. Methods Clinical data of one TTS patient after liver transplantation was retrospectively analyzed. Clinical features, diagnosis and treatment strategies were summarized, and literature review was conducted. Results A 43-year-old female patient successfully underwent split liver transplantation due to primary biliary cirrhosis for 8 years. At postoperative 3 d, the patient developed anxiety, irritation, dyspnea, disorientation, hypotension, N-terminal pro-brain natriuretic peptide (NT-proBNP) of > 35 000 pg/mL, creatine kinase isoenzyme (CK-MB) of 5.9 U/L and troponin I (TnI) of 1.78 μg/L. Electrocardiogram indicated the signs of sinus rhythm. Echocardiography indicated diffuse weakening of the left ventricular wall motion and spherical dilatation of the apex, accompanied with moderate and severe regurgitation of the mitral valve and tricuspid valve. The left ventricular ejection fraction (LVEF) declined to 23%, whereas no abnormal segmental motion of ventricular wall or corresponding electrocardiogram changes were observed. The possibility of acute coronary syndrome was excluded. The InterTAK diagnostic score was 73. The diagnosis of TTS after liver transplantation was considered. Metoprolol, coenzyme Q10, recombinant human brain natriuretic peptide, deacetyl lanatoside and lorazepam were given. Echocardiography at postoperative 10 d showed that the left ventricular function was significantly improved and the LVEF recovered to 50%. The patient was discharged 40 d after liver transplantation. The liver function was recovered well. During postoperative follow-up, she was given with metoprolol till the submission date, and no recurrence was reported. Conclusions TTS after liver transplantation is rare in clinical practice. It is difficult to make the diagnosis. The condition of TTS is severe and clinical prognosis is poor. Prompt diagnosis and interventions should be implemented.
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ObjectiveThe assessment of volume load status in patients with acute heart failure is of great significance for preventing volume overload. The aim of this study was to explore the predictive value of NT-proBNP level and IVC-CI on volume load and prognosis in patients with acute heart failure. MethodsFrom January 2017 to April 2019, the clinical characteristics of 98 patients with acute heart failure diagnosed and treated in the Peking University People's Hospital were retrospectively reviewed in this study. All of them were treated with routine anti-heart failure treatment. According to the level of relative volume balance, they were divided into volume overload group (65 cases) and non-volume overload group (33 cases). All the patients were followed up for 30 days after discharge. The patients with death and cardiogenic rehospitalization were included in the event group (30 cases), and the rest were in the non-event group (68 cases). NT-proBNP and IVC-CI in different volume load groups and different prognosis groups were compared. The volume index levels (serum albumin, hemoglobin, hematocrit, PCWP, CVP) of patients in different volume load groups were compared. The effects of NT-proBNP and IVC-CI on volume load and prognosis of patients were analyzed.ResultsThe levels of NT-proBNP [（1306.39±313.98）pg/mL], PCWP [（19.63±1.95）mmHg] and CVP [（14.65±1.03）cmHg] in the volume overload group were higher than those in the non-volume overload group, while the IVC-CI [（38.26±8.14）%], albumin [（16.23±2.12）g/L], hemoglobin and hematocrit [（36.26±2.78）%] in the volume overload group were lower than those in the non-volume overload group (P0.05). On discharge, the AUC of NT-proBNP, IVC-CI in predicting patients with acute heart failure was respectively 0.806 and 0.847. Although the prediction accuracy was relatively high, the AUC of combined prediction was 0.982, which was significantly higher than that of NT-proBNP and IVC-CI (Z=3.589, 3.274, both P<0.05).Conclusion There is a correlation between NT-proBNP, IVC-CI and volume indexes. The combined detection of NT-proBNP and IVC-CI can help to assess the volume load status of patients with acute heart failure and improve the predictive value of short-term prognosis of patients.
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@#Objective To explore the predictive value of N-terminal-pro-brain natriuretic peptide (NT-ProBNP) for postoperative early outcomes in infants with aortic coarctation (CoA). Methods A retrospective study was conducted in 344 children with CoA admitted to our hospital from September 2014 to October 2017, including 206 males (59.9%) and 138 females (40.1%), with an average age of 0.2-60.0 (7.1±10.6) months. The levels of NT-proBNP, clinical characteristics, imaging data and early follow-up results were collected and analyzed. Results Compared with the normal NT-proBNP group, there were statistical differences in age, the proportion of RACHS-1≥3, the proportion of preoperative pneumonia and dysplastic aortic arch, preoperative cardiac function, left ventricular wall thickness, left ventricular dilatation, hospital stay, ICU duration, ventilator duration, duration of vasoactive drugs use, delayed chest closure, nasal continuous positive airway pressure (nCPAP), postoperative cardiac insufficiency in the abnormal NT-proBNP group (P<0.05). According to multivariate logistic regression analysis, NT-proBNP level (>3 000 pg/mL) was an independent risk factor for prolonged ICU duration [OR=3.17, 95%CI (1.61, 6.23)], prolonged ventilator duration [OR=5.84, 95%CI (2.86, 11.95)], prolonged use of vasoactive drugs [OR=2.22, 95%CI (1.22, 4.02)], postoperative cardiac insufficiency [OR=3.10, 95%CI (1.64, 5.85)]; NT-proBNP level (> 5 000 pg/mL) was an independent risk factor for delayed chest closure [OR=3.55, 95%CI (1.48, 8.50)]. Conclusion NT-proBNP level in children with CoA can be affected by many factors, including age, complexity of congenital heart disease, preoperative cardiac insufficiency, et al. The level of NT-proBNP has predictive value for postoperative early outcomes.
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Objective@#To compare the differences between roles of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and that of echocardiography in early diagnosis of Kawasaki disease (KD).@*Methods@#Medical records of patients with KD at the Department of Pediatrics, Fujian Provincial Hospital from January 2013 to December 2017 were collected retrospectively.The levels of NT-proBNP and the echocardiographic parameters on admission were compared between patients with varying days of fever by the Chi-squared test.@*Results@#A total of 154 patients with typical KD (TKD) were identified.Among them, 104 cases had fever ≤7 days on admission, 90 cases out of them with NT-proBNP≥300 ng/L, 14 cases with coronary artery lesion detected by echocardiography, and 13 cases with positive findings in both NT-proBNP and echocardiography.For patients having ≤7 days of fever, the positive rate of NT-proBNP value was significantly higher than that of echocardiographic examination (χ2=74.05, P<0.05). Forty-four cases had 8-11 days of fever, and among them 7 cases with NT-proBNP≥300 ng/L, 8 cases with coronary artery lesion, 3 cases with two indexes positive.For patients with 8-11 days of fever, there was no significant difference in the positive rate between NT-proBNP and echocardiography (χ2=0, P>0.05). Among 6 total cases who had 12-21 days of fever, 3 cases had coronary artery lesion, none with NT-proBNP≥300 ng/L.For patients with 12-21 days of fever, there was no significant difference in the positive rate between NT-proBNP and echocardiography (χ2=0, P>0.05). A total of 102 cases with incomplete KD (IKD) were enrolled, and among them of 69 cases had fever ≤7 days on admission, 56 cases with NT-proBNP≥300 ng/L, 6 cases with coronary artery lesion, and 6 cases with positive findings in both indexes.For IKD patients with ≤7 days of fever, the positive rate of NT-proBNP value was significantly higher than that of echocardiographic examination (χ2=50.00, P<0.05). Twenty-nine cases had 8-11 days of fever, and among them 5 cases with NT-proBNP≥300 ng/L, 4 cases with coronary artery lesion.For IKD patients with 8-11 days of fever, there was no significant difference in the positive rate between NT-proBNP and echocardiography (χ2=0, P>0.05). In cases with 12-21 days of fever, 2 cases had coronary artery lesion, none with NT-proBNP ≥300 ng/L.Echocardiography revealed coronary artery lesions in 2 cases.For patients with 12-21 days of fever, there was no significant difference in the positive rate between NT-proBNP and echocardiography (χ2=0, P>0.05).@*Conclusions@#Higher levels of NT-proBNP can be helpful for early diagnosis of KD in children, which is a better predictor than echocardiography.
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Objective To explore the value of plasma histones in predicting the prognosis of sepsis patients. Methods The patients with sepsis admitted to intensive care unit (ICU) of Subei People's Hospital of Jiangsu Province Affiliated to Yangzhou University from May 2016 to June 2018 were enrolled as the research subjects, and healthy volunteers were selected as healthy control at the same period. The plasma levels of histones, cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), sequential organ failure assessment (SOFA) score, lactate (Lac), procalcitonin (PCT) on admission 24 hours, and use of vasoconstrictor agents, the length of ICU stay and ICU mortality were recorded. The patients were divided into survival group and death group according to the prognosis, and the differences of each index between the two groups were compared. Multivariate binary Logistic regression analysis was carried out to identify the independent risk factors of death. The correlation between histone and the levels of cTnI, NT-proBNP, PCT and Lac was analyzed. The value of plasma histone, cTnI, NT-proBNP, PCT and Lac in predicting the prognosis of patients was analyzed by receiver operating characteristic (ROC) curve. According to the threshold value of histone in predicting prognosis, the patients were divided into two groups, and the differences of various indicators between the two groups were compared. Results ① A total of 93 sepsis patients were included, with 29 cases of ICU death, and the mortality was 31.2%. ② Compared with the healthy control group, histones, cTnI, NT-proBNP were significant increased, besides, histones, cTnI in the death group were further increased compared with the survival group;in addition, SOFA, proportion of vasoconstrictor use were also significant higher than those in the survival group [histones (mg/L): 0.33 (0.28,0.45) vs. 0.22 (0.17,0.29), cTnI (μg/L): 0.25±0.13 vs. 0.20±0.08, SOFA: 11 (8, 12) vs. 9 (8, 11), the rate of vasopressor use: 93.1% (27/29) vs. 68.8% (44/64), all P < 0.05]. Statistically significant indicators between the two groups were included in multivariate binary Logistic regression analysis. The result showed that the independent risk factors affecting the prognosis of patients were the rate of vasopressor use [odds ratio (OR) = 5.277, P = 0.043] and the level of histone (OR = 79.244, P = 0.036). ③ The plasma histone level were positively correlated with cTnI (r = 0.577, P = 0.000), SOFA (r = 0.469, P = 0.000), NT-proBNP (r = 0.349, P = 0.001) and Lac (r = 0.357, P = 0.000), while there was no significant correlation between histone and PCT (r = 0.133, P = 0.205). ④ ROC curve analysis showed that the area under ROC curve (AUC) of histone predicting prognosis was 0.769 (P = 0.000); when the cut-off point was 0.30 mg/L, the sensitivity and specificity were 72.4% and 81.2% respectively. The AUC of SOFA score was 0.653 (P = 0.018), and the sensitivity and specificity were 58.6% and 70.3% respectively when the cut-off point was 10.50; while cTnI, NT-proBNP, Lac and PCT had little value in predicting the prognosis of patients. ⑤ Compared with the group with histone level lower than 0.3 mg/L, the group with histones level greater than 0.3 mg/L had higher SOFA score, more doses of vasopressor, higher cTnI, NT-proBNP, Lac and PCT levels, and higher ICU mortality [SOFA: 11 (10, 12) vs. 9 (8, 10), use of vasopressor: 84.8% (28/33) vs. 76.7% (46/60), cTnI (μg/L): 0.28 (0.19, 0.32) vs. 0.18 (0.12, 0.22), NT-proBNP (ng/L): 3 624.0 (2 800.0, 5 260.0) vs. 2 512.0 (1 361.8, 3 590.8), Lac (mmol/L): 2.25 (1.85, 3.50) vs. 1.60 (1.25, 2.35), PCT (μg/L): 2.10 (1.30, 4.03) vs. 1.60 (1.26, 2.33), ICU mortality: 48.5% (16/33) vs. 21.7% (13/60), all P < 0.05], while no statistical difference in the length of ICU stay was found. Conclusions The independent risk factors for ICU mortality of sepsis patients were high histone level and the use of vasopressor. Plasma histone can be regarded as an indicator in predicting the prognosis of patients with sepsis.
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Objective To investigate the effects of Sacubitril/Valsartan on amino terminal probrain natriuretic peptide (NT-proBNP),high sensitivity C-reactive protein (hs-CRP),soluble suppression of tumorigenicity 2(sST2)levels and on left ventricular(LV)structure in NYHA Ⅳ heart failure with reduced ejection fraction(HFrEF) patients.Methods A total of 67 HFrEF patients with NYHA Ⅳ were randomly divided into the control group (n =30)receiving conventional medical treatment,and the observation group(n=32)receiving Sacubitril/Valsartan instead of ACEI(or ARB if ACEI induced cough) in conventional medical treatment.NT-proBNP levels were determined by fluorescer-enhanced chemiluminescence.hs CRP levels were detected by latecx enhanced immunoturbidimetric assay.sST2 levels were determined by enzyme-linked immunosorbent assay (ELISA).The modified Simpson method was used to detect left ventricular end-diastolic diameter (LVEDD),LV posterior wall(LVPW)and LV ejection fraction(LVEF).Two groups of patients were treated and followed-up for 6 months.Results Clinical efficacy was better in the observation group than in the control group(effective rate,20 cases or 61.3％ vs.8 cases or 26.7％,P＜0.05).As compared with the control group,the observation group of patients had an increased LVEF[(46.7±9.2) ％ vs.(41.8±8.0)％,P＜0.05]and a decreased LVEDD[(52.6±6.7)mm vs.(58.8±7.5)mm,P＜0.05].After vs.before treatment,NT-proBNP,hs-CRP and sST2 levels were decreased in both control and observation groups [(1 427 ± 219) μg/L vs.(2 615 ± 273)μg/L,(1.14 ± 1.02) mg/L vs.(1.55±1.38)mg/L,(0.30±0.12)μg/L vs.(0.41±0.10)μg/L,all P＜0.05],and the decrements were much more in the observation group than in the control group (P＜0.05).The annual accumulated frequence and duration of hospitalization were less in the observation group than in the control group[(0.8±0.6)times vs.(1.8±1.0) times,(10.2±5.8)d vs.(16.5±7.2)d,P＜0.05].The maintenance dose of tolasemide was lower in the observation group than in the control group [(15.2±8.4)mg vs.(20.6±10.8)mg,P＜0.05].Conclusions Sacubitril/valsartan therapy is safe and effective and it can reduce hs-CRP and sST2 levels and improve the ventricular remodeling in HFrEF patients of HYHA Ⅳ.
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0bjective To investigate the occurrence of frequent intradialytic hypotension in hemodialysis patients and Analyzed influencing factors. Methods The 1 933 hemodialysis sections of 156 maintenance hemodialysis patients in the Huashan hospital affiliated to Fudan University in Shanghai were selected, and divided into frequent intradialytic hypotension and non- frequent intradialytic hypotension depending on whether the incidence of intradialytic hypotension is greater than 20%, and the patients' dialysis data and biochemical examination data are collected for the analysis of influencing factors. Results The incidence of frequent IDH in maintenance hemodialysis patients was 62.18%(97/156), and the pre-dialysis blood pressure of frequent IDH patients were higher than non-frequent IDH patients, frequent IDH patients: (134.02±21.01)/(73.85±10.73) mmHg(1 mmHg=0.133 kPa), non-frequent IDH patients: (124.66 ± 17.89)/(69.32 ± 10.65) mmHg, (t=-2.851,-2.558, P＜0.05), but lower in post-dialysis, frequent IDH patients:(114.91±19.21)/(68.38±11.41) mmHg, non-frequent IDH patients: (127.90± 20.58)/(74.46±11.79) mmHg, (t=3.989, 3.189, P＜0.01). Binary Logistic regression analysis showed that hemoglobin ( OR=0.354, P=0.015) and high-density lipoprotein ( OR=0.155, P=0.003) were protective factors for the occurrence of frequent IDH, and ultrafiltration volume/weight ( OR=6.021, P=0.002) and N-terminal pro-brain natriuretic peptide ( OR=2.687, P=0.020) were risk factors. Conclusions The incidence of frequent IDH in hemodialysis patients is high, and patients with high filtration rate, high N-terminal pro-brain natriuretic peptide, low hemoglobin and high density lipoprotein should be paid close attention to. It is recommended to regularly monitor patients' biochemical indicators, strengthen blood pressure monitoring for high-risk groups, and timely deal with the symptoms of low blood pressure.
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Objective@#To provide basis for early selection of drug intervention or surgical treatment for premature patent ductus arteriosus(PDA) by a dynamic monitoring of serum N-terminal pro-brain natriuretic peptide(NT-proBNP)levels with ultrasonic examination, so as to improve the prognosis of premature infants.@*Methods@#A total of 108 premature infants with gestational age less than 32 weeks and body weight less than 1.5 kg, within 24 h of birth were admitted to the Department of NICU, Harbin Children′s Hospital from June 2016 to December 2018.The serum NT-proBNP levels were measured at 3 d, 6 d, 9 d after birth, and echocardiography was performed at the same time.According to the results of echocardiography and clinical symptoms, infants were divided into haemodynamically significant PDA(hsPDA)(n=29), asymptomatic PDA(asPDA)(n=24)and non-PDA as control group(n=55). Among them, the hsPDA group was further divided into drug treatment group(n=21) and surgical treatment group(n=8). The surgical treatment group was those who failed 2 courses of oral ibuprofen treatment or had contraindications to drug treatment.Arterial catheter ligation was used for surgical treatment group on 9 to 21 days after birth.NT-proBNP levels were detected at 24 hours and 3 days after surgery, and echocardiography was performed at the same time.The levels of serum NT-proBNP were compared between the three groups and before and after the treatment, and the ROC curve of NT-proBNP was drawn to analyze its diagnostic value.@*Results@#(1) At 3 and 6 days after birth, serum NT-proBNP levels were 8 346 pg/ml and 3 340 pg/ml in the hsPDA group, and 2 536 pg/ml and 1 079 pg/ml in the asPDA group, 1 132 pg/ml and 879 pg/ml in the control group, respectively.The levels of NT-proBNP in the hsPDA group were significantly higher than those in the asPDA group(P<0.05), and the levels of NT-proBNP in the asPDA group were higher than those in the control group(P<0.05). At 9 days after birth, serum NT-proBNP levels were 2 231 pg/ml in the hsPDA group, 834 pg/ml in the asPDA group, and 808 pg/ml in the control group.The levels of serum NT-proBNP in the hsPDA group were significantly higher than those in the asPDA group and the control group (P<0.05). There was no significant difference between the asPDA group and the control group (P>0.05). (2)At 3, 6, and 9 d after birth, serum NT-proBNP levels were 9 000 pg/ml, 8 989 pg/ml, 9 000 pg/ml in the surgical treatment group, and 3 741 pg/ml, 2 544 pg/ml and 1 032 pg/ml in the drug treatment group, respectively.The levels of serum NT-proBNP in the surgical treatment group were significantly higher than those in the drug treatment group (P<0.05). The serum NT-proBNP levels in both drug treatment group and surgical treatment group were significantly lower than those before treatment (P<0.05). At 3 d after the operation, the serum NT-proBNP level was 941 pg/ml in the surgical treatment group and 736 pg/ml in the drug treatment group.There was no significant difference between the two groups (P>0.05). (3)At 3 d after birth, the area under the ROC curve of serum NT-proBNP was 0.91 (95%CI 0.865-0.964), and the sensitivity and specificity of NT-proBNP to diagnose hsPDA at 2 343.5 pg/ml were 93.1% and 73.41.% respectively.@*Conclusion@#NT-proBNP level monitoring can be used as a sensitive indicator for early identification of hsPDA, and it has a clinical significance for intervention strategy and intervention time selection.
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Congenital heart disease (CHD) is the most common congenital malformation and also one of the common causes of heart failure in children.At present,the clinical diagnosis of heart failure in children mainly depends on the medical history,symptoms and signs,with strong subjectivity and lack of timely and simple objective criteria,which are easy to be missed.Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-ProBNP) are polypeptides synthesized and secreted by ventricular myocytes,which have good sensitivity to reflect ventricular systolic,diastolic function and pre-and post-load.They have been widely used in various cardiovascular diseases.In recent years,many studies have shown that the plasma concentration of the two can be used to guide perioperative surgical treatment and evaluate the perioperative prognosis risk of children with CHD.This article reviews the application of BNP and NT-ProBNP in children with CHD with heart failure,especially during perioperative period.
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Objective To provide basis for early selection of drug intervention or surgical treatment for premature patent ductus arteriosus(PDA) by a dynamic monitoring of serum N-terminal pro-brain natri-uretic peptide(NT-proBNP)levels with ultrasonic examination,so as to improve the prognosis of premature infants. Methods A total of 108 premature infants with gestational age less than 32 weeks and body weight less than 1. 5 kg,within 24 h of birth were admitted to the Department of NICU,Harbin Children′s Hospital from June 2016 to December 2018. The serum NT-proBNP levels were measured at 3 d,6 d,9 d after birth, and echocardiography was performed at the same time. According to the results of echocardiography and clin-ical symptoms,infants were divided into haemodynamically significant PDA(hsPDA)(n＝29),asymptomatic PDA(asPDA)(n＝24)and non-PDA as control group(n＝55). Among them,the hsPDA group was further divided into drug treatment group(n＝21) and surgical treatment group(n＝8). The surgical treatment group was those who failed 2 courses of oral ibuprofen treatment or had contraindications to drug treatment. Arterial catheter ligation was used for surgical treatment group on 9 to 21 days after birth. NT-proBNP levels were de-tected at 24 hours and 3 days after surgery,and echocardiography was performed at the same time. The levels of serum NT-proBNP were compared between the three groups and before and after the treatment,and the ROC curve of NT-proBNP was drawn to analyze its diagnostic value. Results (1) At 3 and 6 days after birth,serum NT-proBNP levels were 8 346 pg/ml and 3 340 pg/ml in the hsPDA group,and 2 536 pg/ml and 1 079 pg/ml in the asPDA group,1 132 pg/ml and 879 pg/ml in the control group,respectively. The levels of NT-proBNP in the hsPDA group were significantly higher than those in the asPDA group(P<0. 05),and the levels of NT-proBNP in the asPDA group were higher than those in the control group(P<0. 05). At 9 days after birth,serum NT-proBNP levels were 2 231 pg/ml in the hsPDA group,834 pg/ml in the asPDA group, and 808 pg/ml in the control group. The levels of serum NT-proBNP in the hsPDA group were significantly higher than those in the asPDA group and the control group (P<0. 05). There was no significant difference between the asPDA group and the control group (P>0. 05). (2)At 3,6,and 9 d after birth,serum NT-proBNP levels were 9 000 pg/ml,8 989 pg/ml,9 000 pg/ml in the surgical treatment group, and 3 741 pg/ml, 2 544 pg/ml and 1 032 pg/ml in the drug treatment group,respectively. The levels of serum NT-proBNP in the surgical treatment group were significantly higher than those in the drug treatment group (P<0. 05). The serum NT-proBNP levels in both drug treatment group and surgical treatment group were significantly lower than those before treatment ( P < 0. 05 ). At 3 d after the operation, the serum NT-proBNP level was 941 pg/ml in the surgical treatment group and 736 pg/ml in the drug treatment group. There was no signifi-cant difference between the two groups (P>0. 05). (3)At 3 d after birth,the area under the ROC curve of serum NT-proBNP was 0. 91 (95%CI 0. 865-0. 964),and the sensitivity and specificity of NT-proBNP to diagnose hsPDA at 2 343. 5 pg/ml were 93. 1% and 73. 41.% respectively. Conclusion NT-proBNP level monitoring can be used as a sensitive indicator for early identification of hsPDA,and it has a clinical signifi-cance for intervention strategy and intervention time selection.
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Objective To compare the differences between roles of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and that of echocardiography in early diagnosis of Kawasaki disease (KD).Methods Medical records of patients with KD at the Department of Pediatrics,Fujian Provincial Hospital from January 2013 to December 2017 were collected retrospectively.The levels of NT-proBNP and the echocardiographic parameters on admission were compared between patients with varying days of fever by the Chi-squared test.Results A total of 154 patients with typical KD (TKD) were identified.Among them,104 cases had fever ≤7 days on admission,90 cases out of them with NT-proBNP≥300 ng/L,14 cases with coronary artery lesion detected by echocardiography,and 13 cases with positive findings in both NT-proBNP and echocardiography.For patients having ≤ 7 days of fever,the positive rate of NT-proBNP value was significantly higher than that of echocardiographic examination (x2 =74.05,P ＜ 0.05).Fortyfour cases had 8-11 days of fever,and among them 7 cases with NT-proBNP≥300 ng/L,8 cases with coronary artery lesion,3 cases with two indexes positive.For patients with 8-11 days of fever,there was no significant difference in the positive rate between NT-proBNP and echocardiography (x2 =0,P ＞ 0.05).Among 6 total cases who had 12-21 days of fever,3 cases had coronary artery lesion,none with NT-proBNP ≥ 300 ng/L.For patients with 12-21 days of fever,there was no significant difference in the positive rate between NT-proBNP and echocardiography (x2 =0,P ＞ 0.05).A total of 102 cases with incomplete KD (IKD) were enrolled,and among them of 69 cases had fever ≤7 days on admission,56 cases with NT-proBNP ≥ 300 ng/L,6 cases with coronary artery lesion,and 6 cases with positive findings in both indexes.For IKD patients with ≤ 7 days of fever,the positive rate of NT-proBNP value was significantly higher than that of echocardiographic examination (x2 =50.00,P ＜ 0.05).Twenty-nine cases had 8-11 days of fever,and among them 5 cases with NT-proBNP ≥ 300 ng/L,4 cases with coronary artery lesion.For IKD patients with 8-11 days of fever,there was no significant difference in the positive rate between NT-proBNP and echocardiography (x2 =0,P ＞ 0.05).In cases with 12-21 days of fever,2 cases had coronary artery lesion,none with NT-proBNP ≥300 ng/L.Echocardiography revealed coronary artery lesions in 2 cases.For patients with 12-21 days of fever,there was no significant difference in the positive rate between NT-proBNP and echocardiography (x2 =0,P ＞ 0.05).Conclusions Higher levels of NT-proBNP can be helpful for early diagnosis of KD in children,which is a better predictor than echocardiography.
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Objective To explore the relationship between multiple serological indexes and cardiac prog-nosis risk of patients;To compare the four predictive value of prognosis of patients with cardiac surgery. Meth-ods A total of 127 patients treated by cardiopulmonary bypass surgery were enrolled from July 2013 to March 2015 in our department.Their baseline data were recorded.All patients were followed up for 2 years.Patients with adverse outcomes were defined as the unfavorableprognosis group during the follow-up period while the patients with nodisease progression were defined as the favorableprognosis group. Univariate analysis and Cox proportional risk model wereapplied to evaluate the effects of all factors on the patient's prognosis. Meanwhile,the prediction ability of multiple serological indexes in predicting prognosis of patients with cardiac surgery was calculated by ROC curve analysis. Results Multivariate Cox proportional hazard model showed that the △NT-proBNP(P =0.019),△plasma levels of cystatin C(P=0.037),△troponin I(P=0.028)and LVEF(P=0.045)have signifi-cant influence on the prognosis of the patients and the △NT-proBNP has the highest degree(RR = 1.598);The AUC of the NT-proBNP combined with LVEF in diagnosis of patients with cardiac surgery was 0.842,and the sen-sitivity and specificity were 75.3% and 76.2%,respectively. Conclusions The level of △NT-proBNP and LVEF have a good predictive ability for cardiac outcome in patients undergoing surgery,which is expected as a conven-tional evaluation index of cardiac surgery with cardiopulmonary bypass.
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Objective To investigate the diagnostic value of N-terminal pro-brain natriuretic peptide(NT-proBNP) and cardiac troponinⅠ (cTnⅠ) in cardiac arrhythmia.And the value of differential diagnosis between different types of arrhythmia.Methods The 114 patients with arrhythmia inpatients diagnosed were collected as the disease group and 108 healthy subjects were collected as the control group in Department of Cardiology,Guizhou Province People's Hospital from May 2016 to April 2017.The serum levels of NT-proBNP and cTnⅠ were detected by chemiluminescence method.All the data were tested for normality and homogeneity of variance.T test was used to compare the serum levels of NT-proBNP and cTnⅠ between patients with arrhythmia and control group.The level of serological differences of NT-ProBNP and cTnⅠ in patients with ventricular premature beats,atrial flutter,atrial fibrillation and ventricular tachycardia were compared by One-way ANOVA.Results There was no significant differences in sex and age between the disease group and the control group (t=0.24,1.47,all P＞ 0.05).Compared with the control group,the serum levels of NT-proBNP (855.96 ± 101.46 pg/ml vs 369.77± 194.88 pg/ml) and cTnⅠ ± 0.43 ng/ml vs 0.037 ± 0.015 ng/ml) were increased,and the serum levels of NT-proBNP and cTnⅠ were significantly higher than those in healthy control group(t=2.29,5.68,all P＜0.05).The serum level of NT-pro BNP in atrial flutter patients(1 427.07 pg / ml) and the serum level of cTnⅠ(2.52 ng/ml) in ventricular tachycardia patients were the highest in premature ventricular contractions,atrial flutter,atrial fibrillation,ventricular tachycardia and other types of arrhythmia.There had different distribution (P＜0.05) of NT-pro BNP and cTnⅠ serum levels among the four kinds of diseases.Conclusion The serum levels of NT-pro BNP and cTnⅠ have some reference value in the diagnosis of arrhythmia and in the differential diagnosis of different types of arrhythmia.
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Objective To explore the death risk factors of septic myocardial depression (SMD) and their predictive effect, and to set up a death early-warning model. Methods A retrospective analysis was conducted. The patients with SMD admitted to emergency department and rescue room of Beilun Branch of the First Affiliated Hospital of Zhejiang University Medical College from January 2015 to November 2017 were enrolled. The patients were divided into survival group and non-survival group according to 28-day outcome, and the gender, age, and the initial examination parameters [white blood cell (WBC) count, neutrophil (Neut) count, activated partial thromboplastin time (APTT), procalcitonin (PCT), D-dimer, C-reactive protein (CRP), cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left atrium diameter (LAD)] of both groups were compared. Binary logistic regression analysis was conducted on the factors with statistically significant difference analyzed in univariate analysis, and death early-warning model was set up subsequently. For parameters in early-warning model after variable screening, receiver operating characteristic curve (ROC) was applied to evaluate the predictive effect of death. Results A total of 129 patients were enrolled, 34 patients died within 28 days with the mortality of 26.4%. Univariate analysis showed that the PCT, cTnI and NT-proBNP in non-survival group were significantly higher than those of the survival group. However, there was no statistical difference in gender, age, WBC, Neut, APTT, D-dimer, CRP, LVEF, LVEDD or LAD between the two groups. Logistic stepwise regression analysis showed that PCT and cTnI were the independent factors influencing the death of patients with SMD [PCT: odds ratio (OR) =1.495, 95% confidence interval (95%CI) = 1.192-1.876, P = 0.001; cTnI: OR = 11.154, 95%CI = 5.709-17.264, P = 0.004], and the death early-warning model was logP =-3.737+0.402×PCT+2.412×cTnI. According to the statistics of Homser-Lemeshow, the effect of this model was good (χ2= 6.258, P = 0.617). The analysis of ROC displayed that the area under ROC curve (AUC) of the combination of PCT and cTnI for predicting the prognosis of SMD patients was 0.851, and it was significantly higher than that of PCT and cTnI alone (0.738 and 0.719, respectively, both P < 0.05). When the combination of PCT and cTnI was 0.26, the sensitivity was 79.97%, the specificity was 87.01%, the positive predictive value was 71.3%, and the negative predictive value was 91.7%. Conclusions PCT and cTnI are independent factors influencing the death of SMD patients. The combination of PCT and cTnI has predictive value for the prognosis of SMD patients. The death early-warning model of SMD patients can be used to predict the prognosis of SMD patients.
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Objective To evaluate the level of plasma N－terminal pro－brain natriuretic peptide ( NT－proBNP ) in preterm infants with bronchopulmonary dysplasia ( BPD ) after dexamethasone administration and its correlation with the occurrence and severity of BPD.Method The preterm infants in NICU from December 2014 to October 2016 were enrolled in this prospective study.All of the infants were less than 32 weeks′gestational age (GA) and less than 1 500 g birth weight (BW) and they all underwent mechanical ventilation for severe ( stage Ⅲ－Ⅳ) respiratory distress syndrome ( RDS).The infants were assigned to weaning group and non－weaning group according to whether they underwent mechanical ventilation after 14 days of birth.Then the non－weaning group were assigned into the therapy group and control group according to whether treated by dexamethasone.By 14 and 28 days after birth, immunochromatography assay was used to detect the serum NT－proBNP respectively and the results were compared among the groups.Result A total of 157 preterm infants with severe RDS were included , 108 in the weaning group, the remaining 49 in the non－weaning group.(1)Compared with the non－weaning group, the weaning group had higher birth weight and lower plasma NT－proBNP level on day 14 ( P ＜0.05). (2)On day 28, all of the 30 infants in the dexamethasone treated group showed significantly lower plasma NT－proBNP level than the 19 infants in the control group [(2.42 ±0.47) pg/ml vs.(2.90 ±0.44) pg/ml] (P＜0.05).(3)Both of the occurrence of moderate to severe BPD and the plasma NT－pro BNP level on day 28 in the dexamethasone treated group were lower than that in the non－treated group (3/30 vs.8/19) and [(2.72 ±0.51) pg/ml vs.(3.09 ±0.30) pg/ml](P＜0.05).The plasma NT－proBNP level in the infants with BPD was higher than that in the infants without it and the difference was statistically significant ( P＜0.05).Conclusion Dexamethasone could reduce the incidence of BPD and the level of plasma NT －proBNP in infants with severe RDS.The plasma NT－pro BNP level was associated with the occurrence and severity of BPD, thus dynamic monitoring its change could be beneficial.
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Objective To research the impact of renin-angiotensin-aldosterone system (RAAS),NT-proBNP,inflammatory factors and clinical efficacy in chronic heart failure (CHF) patients with Qi deficiency type treated by Buzhong-Yiqi decoction,in order to discuss the mechanism of action.Methods A total of 240 CHF patients with Qi deficiency type were divided into observation group and control group according to random number table in our hospital during 2013.6-2016.6,120 patients in each group.The patients were given conventional western medicine treatment in control group,and the patients were added Buzhong-Yiqi decoction in observation group basesd on the control group.All the patients were continuously treated for 4 weeks.The Qi deficiency type TCM symptoms scores were evaluated before and after treatment.The serum level of renin (REN),angiotensin Ⅱ (Ang Ⅱ),aldosterone (ALD) were detected by electrochemiluminescence.The serum level of N-terminal pro-brain natriuretic peptide (NT-proBNP),hs-CRP,TNF-α,IL-6 was detected by enzyme linked immunosorbent assay.The cardiac index (CI),stroke index (SI),ejection fraction (EF) was measureed by ultrasonic cardiogram.The clinical efficacy was evaluated.Results After treatment,the total effective rate was 70.0％ (84/120) in observation group and 55.0％ (66/120) in control group,and there was statistical significance between two groups (x2=6.153,P＜0.05).The CI,SI,EF of observation group was significantly higher than those of control group (t=3.328,4.524,3.416,all P＜0.01).The serum of REN,Ang Ⅱ,ALD,NT-proBNP of observation group were significantly lower than those of control group (t=2.630,6.122,4.106,5.261,all P＜0.01).The serum of hs-CRP,TNF-α,IL-6 of observation group was significantly lower than those of control group (t=3.879,11.625,7.673,all P＜0.01).The TCM symptoms scores of observation group was significantly lower than that of control group (t=6.117,P＜0.01).Conclusions The clinical efficacy was significant on Qi deficiency type CHF patients treated by Buzhong-Yiqi decoction and it could effectively inhibit the RAAS,NT-proBN,inflammatory factors.