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目的:分析血清脂肪酸结合蛋白与脑钠肽对婴幼儿肺炎合并心衰的诊断价值。方法:选择2013年6月~2015年5月诊断为婴幼儿肺炎患者180例,依据病情严重程度分为普通肺炎组(普通组)125例,婴幼儿肺炎合并全身炎症反应综合征组(SIRS组)35例,婴幼儿肺炎合并心衰组(心衰组)20例。患儿入院后6h内给予空腹抽取静脉血,酶联免疫吸附法检测血清脂肪酸结合蛋白(FABP)与血清钠尿肽(BNP)。比较3组患儿血清中FABP、BNP水平差异。绘制血清脂肪酸结合蛋白与血清钠尿肽受试者工作特征曲线(ROC),计算ROC曲线下面积对婴幼儿肺炎合并心衰患者诊断预测的敏感度与特异度,确定最佳预测阈值。结果:普通组、SIRS组与心衰组患者血清FABP水平[(8.36±1.94)ng/ml比(11.65±1.57)ng/ml比(20.96±3.68)ng/ml,F=2.894],BNP[(21.47±5.70)ng/L比(40.63±6.19)ng/L比(89.46±8.03)ng/L,F=3.903]水平逐渐升高,3组比较差异有统计学意义(P<0.05)。以血清脂肪酸结合蛋白FABP=16.83ng/ml为截断值,预测心衰发生的灵敏度、特异度分别为51.83%、72.90%,ROC曲线下面积为0.69[95%CI=(13.80~19.05),P<0.05]。以血清钠尿肽BNP=59.03ng/L为截断值,预测心衰发生的灵敏度、特异度分别为79.42%、87.05%,ROC曲线下面积为0.86[95%CI=(41.93~90.46),P<0.05]。结论:血清脂肪酸结合蛋白与脑钠肽水平与婴幼儿肺炎病情严重程度存在一定关系。重视患儿血清脂肪酸结合蛋白与脑钠肽水平变化有助于婴幼儿肺炎合并心衰病情判断。
Objective: To analyze the diagnostic value of serum fatty acid binding protein and brain natriuretic peptide in infantile pneumonia complicated with heart failure. Methods: From June 2013 to May 2015, 180 cases of infantile pneumonia were selected and divided into general pneumonia group (general group), 125 cases, infantile pneumonia complicated with systemic inflammatory response syndrome group (SIRS group) ) 35 cases, infantile pneumonia with heart failure group (heart failure group) 20 cases. Venous blood samples were collected from patients for fasting within 6 hours after admission. Serum fatty acid binding protein (FABP) and serum natriuretic peptide (BNP) were detected by enzyme-linked immunosorbent assay. The serum levels of FABP and BNP in the three groups were compared. The receiver operating characteristic curve (ROC) of serum fatty acid binding protein and serum natriuretic peptide was plotted to calculate the sensitivity and specificity of the area under the ROC curve for diagnosis and prognosis of infantile pneumonia complicated with heart failure, and the best prediction threshold was determined. Results: The levels of serum FABP in normal group, SIRS group and CHF group [(8.36 ± 1.94) ng / ml vs (11.65 ± 1.57) ng / ml vs 20.96 ± 3.68 ng / ml, F = 2.894] (21.47 ± 5.70) ng / L (40.63 ± 6.19) ng / L (89.46 ± 8.03) ng / L, F = 3.903]. The difference between the three groups was statistically significant (P <0.05). The sensitivity and specificity of predicting the occurrence of heart failure were 51.83% and 72.90%, respectively. The area under ROC curve was 0.69 [95% CI = (13.80 ~ 19.05) P <0.05]. The sensitivity and specificity of predicting the occurrence of HF were 79.42% and 87.05%, respectively. The area under the ROC curve was 0.86 [95% CI = (41.93 ~ 90.46), P <0.05]. Conclusion: Serum levels of fatty acid binding protein and brain natriuretic peptide have some relationship with the severity of pneumonia in infants and children. Emphasis on serum levels of serum fatty acid-binding protein and brain natriuretic peptide contribute to the diagnosis of pneumonia in infants and young children with heart failure.