Objective:To explore the change in the cerebral natriuretic peptide (BNP) levels in the premature infants with hemodynamically significant patent dectus arteriosus (hsPDA) and its relationship with hemodynamics, and to further clarify the clinical significance of BNP in the judgement of illness condition and treatment in the premature infants with hsPDA.Methods:A total of 106cases of premature infants within 6hof birth whose gestational age was no more than 32weeks were selected and divided into hsPDA group (43cases) and PDA with no hemodynamic significance group (nhsPDA group, 27cases) and no PDA group (nPDA group, 36cases) .The patients in HsPDA group were divided into hsPDA treatment group (33cases) and hsPDA non-treatment group (10cases) according to whether ibuprofen was administrated or not.Echocardiography was performed in the patients in hsPDA treatment group, 7dafter oral ibuprofen administration, and the patients in hsPDA treatment group were divided into hsPDA close group (15cases) and hsPDA non-close group (18cases) .The left atrium (LA) /aortic root diameter (VO) value, diameter of patent arterial duct, left ventricular ejection fraction (LVEF) , shortening fraction, left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were recorded at 1, 3, 7dafter birth of the premature infants in various groups with echocardiography.The level of BNP in plasma was determined by electrochemiluminescence.The correlation analysis was performed between the hemodynamic indexes of echocardiography and the level of BNP in plasma.Results:Compared with nhsPDA group, the LA/VO value, arterial catheter diameter and LVEDD were significantly increased (P＜0.05) .The plasma BNP levels of premature infants in hsPDA close and non-close groups at 1and 3dafter birth were significantly higher than those in nPDA group (P＜0.05) ;the plasma BNP level of the premature infants in hsPDA close group at 7dafter birth was significantly lower than that at 3dafter birth (P＜0.05) .Compared with hsPDA non-treatment group, the LA/VO value, arterial catheter diameter, LEVDD and the plasma BNP level of the premature infants in hsPDA treatment group at 7dafter birth were significantly decreased (P＜0.05) .The plasma BNP level was positively correlated with the LA/VO value and arterial catheter diameter (r=0.727, P＜0.05;r=0.780, P＜0.05) of the premature infants in hsPDA group at 3dafter birth.Conclusion:The level of plasma BNP of premature infants 3 dafter birth is positively correlated with the hemodynamic indexes, and the detection of the changes of the plasma BNP levels is helpful to judge the condition of preterm infants with hsPDA and to provide basis for its diagnosis.%目的:探讨有血流动力学意义的动脉导管未闭 (hsPDA) 早产儿血浆脑钠肽 (BNP) 水平变化及其与血流动力学的关系, 进一步阐明BNP在hsPDA早产儿病情判断和治疗中的临床意义.方法:出生6h内且胎龄≤32周的早产儿106例, 分为hsPDA组 (43例) 、无血流动力学意义的动脉导管未闭组 (nhsPDA组, 27例) 和非动脉导管未闭组 (nPDA组, 36例) .hsPDA组患儿根据是否服用布洛芬分为hsPDA治疗组 (33例) 和hsPDA非治疗组 (10例) , hsPDA治疗组患儿给予布洛芬口服治疗后第7天复查超声心动图, 并根据超声心动图结果将hsPDA治疗组分为hsPDA关闭组 (15例) 和hsPDA未闭组 (18例) .各组早产儿出生后第1、3和7天行超声心动图检查, 记录左心房 (LA) /主动脉根部内径 (VO) 值、动脉导管直径、左室射血分数 (LVEF) 、短轴缩短率、左室舒张末期内径 (LVEDD) 和左室收缩末期内径 (LVESD) , 采用电化学发光法测定血浆BNP水平.对超声心动图血流动力学指标和血浆BNP水平进行相关性分析.结果:与nhsPDA组比较, hsPDA组早产儿LA/VO值、动脉导管直径和LVEDD均明显升高 (P＜0.05) ;hsPDA关闭组和未闭组早产儿出生后1和3d血浆BNP水平明显高于nPDA组 (P＜0.05) ;hsPDA关闭组早产儿出生后第7天血浆BNP水平明显低于出生后第3天 (P＜0.05) .与hsPDA非治疗组比较, hsPDA治疗组早产儿第7天LA/VO值、动脉导管直径、LVEDD和BNP水平均明显降低 (P＜0.05) .出生后3dhsPDA组早产儿血浆BNP水平与LA/VO值和动脉导管直径呈正相关关系 (r=0.727, P＜0.05;r=0.780, P＜0.05) .结论:早产儿出生第3天后血浆BNP水平与血流动力学指标呈正相关关系, 检测其水平变化有助于判断hsPDA早产儿病情, 为诊断提供依据.
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