目的 探讨血浆N末端B型钠尿肽前体(N-terminal pro-B-type natriuretic peptide，NTproBNP)在预测中重度支气管肺发育不良(bronchopulmonary dysplasia，BPD)风险中的临床价值。方法 采用前瞻观察性研究方法，选择 2021 年 6月—2022 年 12 月福建省妇幼保健院新生儿科收治的胎龄＜30周极/超早产儿 95 例。分别于出生后第 1、7、14、21 天检测NTproBNP水平并收集住院期间基本资料，根据美国国家儿童健康与人类发展研究所(National Institute of Child Health and Human Development，NICHD)诊断标准，分为无-轻度BPD组(n=74)和中-重度BPD组(n=21)。比较 2 组不同时间点NTproBNP水平。结果 中-重度BPD组胎龄、出生体质量均低于无-轻度BPD组(P＜0。05);中-重度BPD组胎膜早破＞18 h、≥3级新生儿呼吸窘迫综合征(respiratory distress syndrome，RDS)、有创机械通气时间＞7 d、症状性动脉导管未闭(symptomatic patent ductus arteriosus，sPDA)、晚发型败血症、早产儿视网膜病(retinopathy of prematurity，ROP)的发生率均高于无-轻度BPD组，差异有统计学意义(P＜0。05)。无-轻度BPD组NTproBNP水平在出生后第 1天最高，中-重度BPD组NTproBNP水平在出生后第 7 天最高，随后逐渐降低。中-重度BPD组各时间点NTproBNP水平均高于无-轻度BPD组，差异有统计学意义(P＜0。05)。出生后第 1 天NTproBNP水平为 5 631。52 pg/mL，是中重度BPD最佳预测参考值，受试者工作特征(receiver operating characteristic，ROC)曲线下面积为 0。89(95%CI 0。83～0。95)，诊断准确性为 85。71%。结论 出生后第 1 天NTproBNP水平有助于早期预测中重度BPD发病风险，动态监测NTproBNP趋势可能对疾病防治提供一定参考价值。
Predictive Value of Plasma N-Terminal Pro-B-Type Natriuretic Peptide Precursors for Moderate and Severe Bronchopulmonary Dysplasia
Objective To explore the clinical value of plasma N-terminal pro-B-type natriuretic peptide(NTproBNP)in predicting the risk of moderate to severe bronchopuldysplasia(BPD).Methods A prospective observational study was used to select 95 extremely/ultra-premature infants with gestational age<30 weeks from June 2021 to December 2022 in the department of neonatology,Fujian Maternity and Child Health Hospital.NTproBNP levels were detected at 1,7,14 and 21 days after birth,and basic data were collected during hospitalization,according to the National Institute of Child Health and Human Development(NICHD)diagnostic criteria were divided into no-mild BPD group(n=74)and moderate-severe BPD group(n=21).The NTproBNP level was compared between the two groups at different time points.Results The gestational age and birth weight of moderate-severe BPD group were lower than those of no-mild BPD group(P<0.05).The incidences of premature rupture of membranes>18 h,≥grade 3 respiratory distress syndrome(RDS),invasive mechanical ventilation time>7 d,symptomatic patent ductus arteriosus(sPDA),late-onset sepsis and retinopathy of prematurity(ROP)in moderate-severe BPD group were higher than those in non-mild BPD group,the difference was statistically significant(P<0.05).The level of NTproBNP in the non-mild BPD group was the highest on the 1st day after birth,and the level of NTproBNP in the moderate-severe BPD group was the highest on the 7th day after birth,and then gradually decreased.The NTproBNP level in moderate-severe BPD group was higher than that in no-mild BPD group at all time points,and the difference was statistically significant(P<0.05).The level of NTproBNP on the first day after birth was 5 631.52 pg/mL,which was the best prediction reference value for moderate to severe BPD.The area under receiver operating characteristic(ROC)curve was 0.89(95%CI 0.83-0.95),and the diagnostic accuracy was 85.71%.Conclusion The level of NTproBNP on the first day after birth is helpful for early prediction of the risk of moderate and severe BPD,and dynamic monitoring of NTproBNP trend may provide some reference value for disease prevention and treatment.
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