Clinical Research Of The Value Of Measurement Of Plasma Brain Natriuretic Peptide And High Sensitive C-reactive Protein In Congenital Heart Disease

Objective: A prospective study was used to explore the value ofmeasurement of plasma brain natriuretic peptide(BNP)and high sensitive Creactive protein (hsCRP) in congenital heart disease，through evaluating thelevel of plasma BNP and hsCRP in congenital heart children and healthychildren.Method: We studied the children diagnosed with CHD in our hospitalfrom2010March to2012March that were accepted operation in departmentof cardiac surgery，and chose ninety-six randomly that included59cases ofboys and27cases of girls with their age ranged from3months to10years oldas object; while the control group involved twenty-one of healthy childrenfrom outpatient physical normal children with their age ranged from5monthsto7.5years old. The control group had21cases that included13cases of boysand8cases of girls.96cases of congenital heart disease according to whethercomplicated with heart failure，they were divided into two groups，namedcongenital heart disease complicated with heart failure group included27casesand congenital heart disease without heart failure group included69cases. Thediagnostic criteria for heart failure were accorded the standard which weremade by Chinese Medical Association Pediatric Branch of cardiovasculargroup. All of the patients lied quietly when taking a blood sample in the nextday morning after admission.(1) BNP detection: Took venous blood3ml intochilled tubes containing EDTA，centrifuged for30min (3500r/min，10min).The method for measuring of plasma BNP was Triage Meter Pro，whichcould accurate determination of5~4000pg/ml. The Triage Meter Proinstruments and reagents were produced by American Biosite Company. If themeasured value <5pg/ml，user-defined it as5pg/ml.(2) hsCRP detection: Blood sample (1ml) for hsCRP measurement was collected into routine tube，then determined by immunofluorescent quantitative determination in dry. Theinstruments i-CHROMA Reader and C reactive protein reagents were bothproduced by South Korea BODTIECH Company. If the measured value<0.5mg/l，user-defined it as0.5mg/l. All statistical analysis was preceded by theapplication of SPSS13.0statistic software. The data was divided intomeasurement data and count data by its nature. Median (inter-quartilerange)(M(Q))was used to depict the measurement data with skeweddistribution or non-normal distribution information. The data of BNP andhsCRP was skewed distribution, so comparisons of them between two groupsor more groups were analyzed by non-parametric tests (Mann-Whitne U test).While partial distribution was used by Spearman correlation analysis. Settingα=0.05， P<0.05for the difference was statistically significant.Result:1. the comparisons of age among three groups.All of cases ages ranged4months to10years. The age of CHD with HFgroup、CHD without HF and control group were respectively1.7(2.60)，2.3(3.00) and3.00(3.15) years old， there were no difference among them.(Fig.1)2. the comparison of BNP and hsCRP between boys and girls.The levels of BNP and hsCRP in boys group were36.25(19.60pg/ml，0.77(1.67)mg/l，while girls group37.20(13.90)pg/ml，0.80(0.95)mg/l，thedifference was not statistically significant.(Table1)3. the comparison of BNP and hsCRP among three groups.The levels of plasma BNP in CHD with HF group and CHD without HFwere respectively120(146.30) pg/ml，35.80(5.75) pg/ml，while controlgroup7.80(10.40) pg/ml.The levels of plasma hsCRP in CHD with HF group and CHD without HFwere respectively4.10(2.90)mg/l，1.50(0.35) mg/l，while control group0.75(0.80)mg/l. There existed significant difference (P <0.05).(Table2) 4. the comparisons of BNP and hsCRP with different types of CHD betweentwo groups of CHD with heart failure or not.The levels plasma of BNP with different types of CHD in CHD with HFgroup respectively were ASD of81.10(21.80) pg/ml; VSD of138.50(172.88) pg/ml; PDA of120.00(194.35) pg/ml，while ASD of38.00(20.05)pg/ml; VSD of36.75(4.00) pg/ml，PDA of33.30(6.65) pg/ml; TOF of39.65(7.20) pg/ml in CHD without HF group. There existed significantdifference (P <0.05).(Table3)The levels of hsCRP with different types of CHD in CHD with HF grouprespectively were ASD of4.00(0.20)mg/l；VSD of4.65(1.75)mg/l；PDA of3.50(5.20)mg/l; while ASD of1.60(2.10)mg/l；VSD of1.75(0.50)mg/l；PDA of1.64(0.90)mg/l; TOF of1.40(0.32)mg/l in CHD without HFgroup. There existed significant difference (P <0.05).(Table4)5. There was positive correlation between plasma BNP and hsCRP in CHDchildren.(r1=0.65，r2=0.74P<0.05)。(Fig.2, Fig.3)Conclusions:1. Serum BNP level is sensitive and specific for the diagnosis of CHDcomplicated with CHF.2. BNP activation in children congenital heart disease bears the hallmarks ofchronic heart failure， relating to symptom severity and ventriculardysfunction.3. The serum levels of BNP and hsCRP have important significance inevaluating functional assessment and prognosis of children with CHD, alsocould be wildly used in clinic.