Plasma NT-Probnp Merged With Congenital Heart Disease Children With Pulmonary Hypertension Level Of Clinical Significance

objective:The purpose of this study is to identified the relationship betweencongenital heart disease (CHD) complicating pulmonary hypertension (PAH) andplasma brain natriuretic peptide precursor (NT-proBNP).We detected the level ofplasma amino-terminal pro-brain natriuretic peptide (n-Terminal pro-b-typenatriuretic peptide NT-proBNP) in children who had being congenital heart disease(congenital heart disease, CHD) with various degree of pulmonary hypertension(pulmonary artery hypertension, PAH).Methods:Randomly pick up91patients who had being congenital heart disease (CHD) throughCardiothoracic Surgery identified enrolled in Hunan Children’s HospitalCardiothoracic Surgery from January2012to December2012. CHD patients in ourhospital echocardiography, according to the tricuspid valve regurgitation rate andestimate the pulmonary artery systolic pressure (pulmonary artery systolic pressure,sPAP) of high and low, divided into pulmonary hypertension group (sPAP≥30mmHg)and without pulmonary hypertension group (sPAP <30mmHg), a total of2groups.Pulmonary hypertension group (sPAP≥30mmHg) is divided into three subgroups:severe pulmonary hypertension group (sPAP≥70mmHg), moderate pulmonaryhypertension group (50mmHg≤sPAP <70mmHg) and mild pulmonaryhypertension group (30mmHg≤sPAP <50mmHg). Using enzyme-linkedimmunosorbent method (enzyme linked immunosorbent assay, ELISA) detection ofplasma brain natriuretic peptide (NT-proBNP), and analysis of plasma brainnatriuretic peptide concentration variables associated with the pulmonary arterypressure, etc. Results：1. Children with pulmonary hypertension group were divided into mild, moderate,severe PAH, PAH, mild, moderate, severe PAH four groups of the NT-proBNP inplasma levels in children with difference by the single factor analysis of variance, thepreoperative and postoperative differences have statistical significance (P <0.05).2. Incorporating congenital heart disease children with pulmonary hypertension groupand divided them into mild, moderate, severe PAH, PAH group, mild, moderate,severe PAH group with plasma NT-proBNP levels respectively in the preoperativeand postoperative1day,3days,7days,2weeks and4weeks which had statisticallysignificant (P <0.05). Mild PAH with PAH group in the preoperative andpostoperative1day plasma NT-proBNP level do not have statistical significance(P>0.05); Moderate PAH group, severe PAH group respectively with no PAH plasmaNT-proBNP in horizontal comparison, in the preoperative and postoperative1dayhave statistical significance (P <0.05); Mild PAH group, moderate pahs respectivelywith no PAH group on postoperative days3and7,2weeks and4weeks plasma NT-proBNP level do not have statistical significance (P>0.05); Severe PAH with PAHgroup on postoperative days3and7,2weeks and4weeks plasma NT-proBNP levelcomparison has statistical significance (P <0.05).3. Monitoring myocardial enzymology of all children (CK-MB, myoglobin, troponin)and blood gas analysis index, CK-MB, myoglobin, troponin levels of oxygen partialpressure in the absence of PAH, mild, moderate, severe PAH group each group hasstatistical significance (P <0.05); Children with co2partial pressure in differentgroups do no have statistical significance (P>0.05). Children with breathing machinein time, the length of time in the absence of PAH, mild, moderate, severe PAH grouphas statistical significance between groups (P <0.05). Mild PAH group, moderatepahs respectively with no PAH group CK-MB, troponin, myoglobin, there were nostatistical significance (P>0.05); the moderate PAH group’s and the non-PAHgroup’s of breathing machine in time, length of hospital stay was statisticallysignificant (P <0.05); Severe PAH with PAH group CK-MB, troponin, myoglobin,breathing machine in time and the length of being in hospital have statistically significant (P <0.05).4. Free of PAH group of children, children with mild PAH group, moderate PAHgroup of children, children with severe PAH group of preoperative plasma NT-proBNP in pulmonary artery pressure measurement with rank correlation, thecorrelation coefficient was0.735(P <0.05), showed that congenital heart diseasecombined plasma brain natriuretic peptide level in patients with pulmonary arterialhypertension is higher, and the higher level, increased with the increasing of degree ofpulmonary hypertension and pulmonary artery pressure and both of them havepositively correlated.5. By intraoperative measurement of pulmonary artery pressure to decide if child haspulmonary hypertension and preoperative plasma NT-proBNP ROC curve, ROCarea is0.861(P <0.05), the size of the confidence interval is (0.738,0.938). Theresult shows that the plasma NT-proBNP can be as a diagnosis whether children withcongenital heart disease with pulmonary hypertension noninvasive indicator.6. Clinical observation found that children with PAH united in low blood pressure,heart failure, along with the status such as malnutrition, the change and the prognosisof the NT-proBNP have certain relations.7. Preoperative plasma NT-proBNP as dependent variable, age, sex, CHD childrendefect size and grade of cardiac function, length of hospital stay, oxygen partialpressure, co2partial pressure and the decrease of the blood and the survival cases asindependent variables, multiple stepwise regression analysis, can be obtained inchildren with CHD on the defect size, level of cardiac function, breathing machinetime, hospitalization time affect plasma NT-proBNP.Conclusion:1.Congenital heart disease,merge pulmonary hypertension in patients with plasmabrain natriuretic peptide levels are rising, and it increased with the increasing ofdegree of pulmonary hypertension and elevated level has positively related withpulmonary artery pressure, namely as the pulmonary artery pressure increased, theconcentration of plasma brain natriuretic peptide and a higher proportion of. Mergerof moderately severe pulmonary hypertension of congenital heart disease in patients with plasma NT-proBNP in predicting it could play an important role in the severityof PAH.2. Reflects the level of serum NT-proBNP left to right shunt heart volume andpressure load, first on the left to right shunt congenital heart disease associated withpulmonary hypertension has high diagnostic value. The BNP can choose the besttreatment for clinical surgery opportunity and provide theoretical basis and methods.