| Objective: Congestive Heart Failure (CHF) is a common urgent and critical disease in children. Dyspnea is one of the most common clinical signs of CHF, and at the same time the acute dyspnea is one of the most important symptoms in critical pneumonia. There is a concept that the serious pneumonia in children can combine with CHF in our country. But it is difficult to differentiate the cardiac dyspnea from pulmonary cause in children with critical pneumonia, and there has been divergence about whether critical pneumonia can combine with CHF. In recent years, many studies have found that the levels of many kinds of polypeptides increase significantly in patients with CHF, and supposed that these polypeptides may take part in the development of CHF. Many foreign clinical studies show that cardiac natriuretic peptide is a diagnosis indicator of CHF, especially that B-type or brain natriuretic peptide (BNP) may have utility in discriminating acute dyspnea due to CHF or other cause accurately in adult. However there are few studies on this subject in children. This s tudy was d esigned t o o bserve t he c hange o f N PY a nd B NP i n children w ith CHF or with pneumonia, to discover the role of BNP and NPY in CHF, and to assess the utility of BNP and NPY in differentiating CHF from pulmonary disease in sick children with dyspnea, and to confirm if CHF can be combined with critical pneumonia in children.Methods: Blood samples were collected from 24 children with CHF, 23 childrenwith pneumonia and 18 children who were recognized with CHF combined with pneumonia. All of them had fatigue, shortness of breath, dyspnea, etc. 15 healthy children were normal controls. The concentration of BNP was measured with BNP ELISA KIT, and the level of NPY was measured with NPY RIA test. Statistic assay: Results were reported as mean SD (x s) . The data were treated with SPSS 10.0 statistical software.Results: Patients with CHF(n=24) had BNP level of 141.548 75.989pg/ml, which was significantly higher than that of patients with pneumonia (n=23) whose BNP level was 24.996+14. 566 pg/ml(P<0.01), and higher than that of patients who were recognized with CHF combined with pneumonia(n=l 8) whose BNP was 1 13.728 87.050 pg/ml(P<0.05) ,and higher than that of healthy children whose BNP level was 19.311 10. 295 pg/ml(P<0.01). BNP level of patients who were recognized with CHF combined with pneumonia was significantly higher than that of patients with pneumonia and that of healthy children. There was no significant difference in BNP levels between the latter two groups. Patients with CHF had NPY level of 2.17.789 + 25. 272 pg/ml, which was significantly higher than that of patients with pneumonia whose NPY level was!90.704 18. 552pg/ml(P<0.01) and that of healthy children whose NPY level was!88.763 + 17. 324pg/ml(P<0.01). There was no significant difference in NPY levels between the latter two groups. There was no significant difference in age among the four groups. Patients with CHF were divided into two groups. The group of acute or decompensated CHF(n=9) had BNP level of 223.217 + 47. 531pg/ml, which was significantly higher than that of chronic CHF(n=15) with BNP level of 92.546 + 36. 537 pg/ml (p<0.01). But there was no difference in the levels of NPY between the two groups. There was a significant positive correlation between the levels of BNP and NPY in the patients with CHF(r=0.684, p<0.01). There were no significant relationships between them in the other two groups. The area under the receive operator characteristic (ROC) curve, which determines the diagnostic utility of BNP in separating CHF from pneumonia, was 0.978(P<0.01); the area about NPY was 0.813(P<0.01). BNP level of 3 9pg/ml had sensitivity of 95.8% and specificity of 82.6% for differentiating CHF frompneumonia. NPY level of 201pg/ml had sensitivity of 79.2% and specificity of 69.6% for differentiating CHF from pneumonia. In the 18 patients who were diagnosed CHF combined with critical pneumonia, there were 11 with BNP levels above 39pg/ml. Their levels of...
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