LVEF、NT-proBNP联合cTnI对先天性心脏病患儿术后低心排血量综合征的预测价值

Predictive value of LVEF, NT-proBNP, combined cTnI in children with low cardiac output syndrome after congenital heart disease surgery

摘要:

目的 分析左心室射血分数（LVEF）、N-末端脑钠肽前体（NT-proBNP）联合心肌肌钙蛋白I（cTnI）对先天性心脏病患儿术后低心排血量综合征的预测价值。方法 选取2019年6月—2021年9月于上海儿童医学中心三亚市妇女儿童医院接受体外循环下先天性心脏病矫正术的121例患儿，按术后是否发生低心排血量综合征分为低心排血量综合征组和非低心排血量综合征组。比较两组患儿的性别、年龄、体重、主动脉阻断时间、体外循环时间、机械通气时间、血管活性药物评分及先天性心脏病类型；比较两组患儿的LVEF、NT-proBNP、cTnI；采用多因素Logistic回归模型分析先天性心脏病患儿术后低心排血量综合征发生的影响因素；绘制ROC曲线，分析LVEF、NT-proBNP、cTnI及三者联合对先天性心脏病患儿术后低心排血量综合征发生的预测效能。结果 121例体外循环下先天性心脏病矫正术患儿术后发生低心排血量综合征39例，发生率为32.23%；两组的年龄、主动脉阻断时间、体外循环时间、机械通气时间及LVEF、NT-proBNP、cTnI比较，差异均有统计学意义（P <0.05），低心排血量综合征组年龄小于非低心排血量综合征组，LVEF低于非低心排血量综合征组，主动脉阻断时间、体外循环时间、机械通气时间长于非低心排血量综合征组，NT-proBNP、cTnI高于非低心排血量综合征组；多因素Logistic回归分析发现，年龄［O^R=0.436（95% CI：0.186，0.769）］、LVEF［O^R=0.877（95% CI：0.779，0.987）］是先天性心脏病患儿术后低心排血量综合征发生的保护因素（P <0.05），主动脉阻断时间［O^R=3.652（95% CI：1.425，7.002）］、体外循环时间［O^R=3.702（95% CI：1.463，8.652）］、机械通气时间［O^R=2.025（95% CI：1.165，5.385）］、NT-proBNP［O^R=1.005（95%CI：1.003，1.007）］、cTnI［O^R=3.758（95% CI：1.549，9.121）］是危险因素（P <0.05）；ROC曲线分析结果显示，LVEF、NT-proBNP、cTnI及三者联合预测脑先天性心脏病患儿术后低心排血量综合征发生的敏感性分别为76.5%（95% CI：0.682，0.875）、81.2%（95% CI：0.751，0.932）、78.6%（95% CI：0.693，0.887）、86.5%（95% CI：0.793，0.932），特异性分别为73.5%（95% CI：0.602，0.835）、79.6%（95% CI：0.693，0.900）、75.5%（95% CI：0.659，0.861）、84.2%（95% CI：0.782，0.935）。结论 LVEF、NT-proBNP、cTnI是先天性心脏病患儿术后低心排血量综合征发生的独立预测因子，且三者联合可有效预测低心排血量综合征的发生。

Abstract:

Objective To analyze the predictive value of left ventricular ejection fraction (LVEF) and N-terminal pro brain natriuretic peptide (NT-proBNP) combined cardiac troponin I (cTnI) in children with low cardiac output syndrome after congenital heart disease surgery.Methods A total of 121 children with congenital heart disease undergoing cardiopulmonary bypass in Sanya Women and Children's Hospital Managed by shanghai Children's Medical Center Sanya, from June 2019 to September 2021, were selected. According to postoperative low cardiac output syndrome, they were divided into low cardiac output syndrome group and non-low cardiac output syndrome group. Sex, age, body weight, aortic block time, cardiopulmonary bypass time, mechanical ventilation time, vasoactive drug score, congenital heart defect type, LVEF, NT-proBNP, and cTnI were compared between the two groups. Logistic multiple regression model was used to analyze the risk factors of postoperative low cardiac output syndrome in children with congenital heart defect, to analyze the value of LVEF, NT-proBNP, CTNI, and their combination in predicting the occurrence of postoperative low cardiac output syndrome in congenital heart defect children.Results 39 LCOS in 121 children with congenital heart disease, the incidence rate was 32.23%. There were significant differences in age, aortic occlusion time, cardiopulmonary bypass time, mechanical ventilation time, LVEF, NT-proBNP, and cTnI between the two group by t test (P < 0.05); age and LVEF of LCOS group were lower than those of non-LCOS group; aortic occlusion time, extracorporeal circulation time and mechanical ventilation time were longer than those of non-LCOS group; NT-proBNP and cTnI were higher than those of non-LCOS group. The logistic regression results found that, age [O^R = 0.436 (95% CI: 0.186, 0.769)], LVEF [O^R = 0.877 (95% CI: 0.779, 0.987) ] were protective factors for the occurrence of LCOS after pediatric congenital heart disease (P < 0.05), Time to aortic blockade [O^R = 3.652 (95% CI: 1.425, 7.002) ], time of cardiopulmonary bypass [O^R = 3.702 (95% CI: 1.463, 8.652) ], mechanical ventilation time [O^R = 2.025 (95% CI: 1.165, 5.385) ], NT-proBNP [O^R = 1.005 (95% CI: 1.003, 1.007) ], and cTnI [O^R = 3.758 (95% CI: 1.549, 9.121)] were risk factors (P < 0.05); ROC result display that the sensitivity of LVEF, NT-proBNP, cTnI, and the combined prediction of LCOS occurrence after congenital heart disease in brain children is 76.5% (95% CI: 0.682, 0.875), 81.2% (95% CI: 0.751, 0.932), 78.6% (95% CI: 0.693, 0.887), 86.5% (95% CI: 0.793, 0.932) respectively, and speciality were 73.5% (95% CI: 0.602, 0.835), 79.6% (95% CI: 0.693, 0.900), 75.5% (95% CI: 0.659, 0.861), and 84.2% (95% CI:0.782, 0.935), respectively.Conclusion LVEF, NT-proBNP, and cTnI were independent predictors of LCOS after pediatric congenital heart disease, and the combination of the three could effectively predict the occurrence of LCOS.