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目的探讨血浆N端脑钠肽前体(NT-pro BNP)及Tei指数评价新生儿缺氧性肺动脉高压(HPH)患儿右心室功能的意义。方法选择2012年6月至2013年11月本院新生儿重症监护病房收治的缺氧性新生儿为观察组,根据生后第1天是否合并肺动脉高压分为HPH组与非HPH组。HPH组依据其生后第7天的肺动脉压力(PASP)是否恢复正常分为HPH恢复组和HPH未恢复组。选择同期入院无缺氧病史的新生儿为对照组。所有研究对象均于生后第1天、HPH组于生后第7天测定PASP、右室Tei指数、右室射血分数(RVEF)、E/A比值;所有对象于超声检查后1 h内采集静脉血,测定血浆NT-pro BNP水平。结果研究期间共收治有缺氧史的新生儿72例,合并肺动脉高压46例,其中轻度HPH组20例,中度HPH组18例,重度HPH组8例,非HPH组26例;共纳入对照组22例。生后第1天各组RVEF、E/A比值比较,中度及重度HPH组均低于对照组、非HPH组及轻度HPH组,重度HPH组低于中度组,差异有统计学意义(P<0.05)。生后第1天各组Tei指数及血浆NT-pro BNP比较,HPH组和非HPH组均高于对照组,中度及重度HPH组高于非HPH组和轻度HPH组,重度HPH组高于中度HPH组,差异有统计学意义(P<0.05)。生后第7天HPH恢复组RVEF、E/A比值高于第1天,Tei指数及血浆NT-pro BNP低于第1天,差异有统计学意义(P<0.05);HPH未恢复组Tei指数及血浆NT-pro BNP低于第1天,差异有统计学意义(P<0.05),RVEF、E/A比值与第1天差异无统计学意义(P>0.05)。生后第1天Tei指数与血浆NT-pro BNP呈正相关(r=0.826,P<0.001),并且二者均与PASP正相关(r分别为0.555,0.504,P<0.001)。结论新生儿HPH患儿存在右心功能障碍,其血浆NT-pro BNP水平、右室Tei指数与PASP高低密切相关,有助于右心功能障碍的诊断。
Objective To investigate the significance of plasma NT-pro BNP and Tei index in evaluating right ventricular function in neonates with hypoxic pulmonary hypertension (HPH). Methods From June 2012 to November 2013, neonates admitted to neonatal intensive care unit in our hospital were divided into observation group (HPH group) and non-HPH group according to whether pulmonary hypertension was combined on the first day after birth. HPH group was divided into HPH recovery group and HPH non-recovery group according to whether the pulmonary artery pressure (PASP) returned to normal on the seventh day after birth. Select the same period of hospitalization without hypoxia history of neonates as control group. All subjects were on the first day after birth. PASP, Tei index, right ventricular ejection fraction (RVEF) and E / A ratio were measured in HPH group on the 7th day after birth. All subjects within 1 h after ultrasound examination Venous blood was collected and plasma NT-pro BNP level was measured. Results During the study period, 72 newborns with history of hypoxia and 46 patients with pulmonary hypertension were included. Among them, 20 were mild HPH, 18 were moderate HPH, 8 were severe HPH and 26 were non-HPH. Control group of 22 cases. On the first day after birth, the RVEF and E / A ratios in each group were lower than those in the control group, non-HPH group and mild HPH group, and severe HPH group were lower than those in the moderate and severe HPH group, the difference was statistically significant (P <0.05). On the first day after birth, the Tei index and the plasma NT-pro BNP in each group were higher than those in the control group, while those in the moderate and severe HPH group were higher than those in the non-HPH group and mild HPH group, and those in the severe HPH group In moderate HPH group, the difference was statistically significant (P <0.05). On the 7th day after birth, the RVEF and E / A ratio of HPH recovery group was higher than that of the 1st day, and the Tei index and plasma NT-pro BNP level were lower than that of the 1st day (P <0.05) Index and plasma NT-pro BNP levels were lower than those on the first day (P <0.05). There was no significant difference between the RVEF and E / A ratios and the first day (P> 0.05). On the first day after birth, Tei index was positively correlated with plasma NT-pro BNP (r = 0.826, P <0.001), and both were positively correlated with PASP (r = 0.555,0.504, P <0.001, respectively). Conclusion There is a right heart dysfunction in neonates with HPH. The plasma NT-pro BNP level and the Tei index of right ventricle are closely related to the level of PASP, which is helpful for the diagnosis of right heart dysfunction.