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根据血浆中NT-ProBNP的水平预测肠病毒-71感染的严重程度

By LabMedica International staff writers
Posted on 04 Jan 2017
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图片:XE-2100自动化血液参数分析仪(图片蒙Sysmex公司惠赐)。
图片:XE-2100自动化血液参数分析仪(图片蒙Sysmex公司惠赐)。
手足口病(HFMD)由多种人类肠病毒引起,主要是肠病毒71 (EV71)和柯萨奇病毒A16 (CA16),其特征为发烧和手、足、口上起水疱疹。

心肌排出等摩尔的脑钠尿肽(BNP)和N末端B型钠尿肽前体(NT-proBNP)。它们的水平随血流动力学应激的增强而升高,它们在心血管生理(血管舒张)与肾生理(尿钠排泄)中有着明确的作用,可防止体液过剩和高血压。

位于长沙的湖南儿童医院的科学家2012年1月至2013年12月从儿科重症监护室招募了282名手足口病患者,其中183人(64.89%)是男孩,全组的年龄中值为21个月。如果发现有更严重的并发症,如脑炎、脑膜炎、急性弛缓性瘫痪和心呼吸道衰竭,或者发现死亡,则认为是严重手足口病例并记录下来。

在入院后一小时内收集用以检测NT-proBNP的静脉血样,并立即储藏在−70 °C的环境下。以每分钟3,000转的速度离心样本,持续20分钟,并用法国里昂生物梅里埃公司的电化学发光免疫测定Elecsys NT-proBNP分析。不告诉临床医务人员NT-proBNP的值,以避免检验结果影响临床干预。用日本神户Sysmex公司的XE-2100血液参数自动分析仪确定红细胞(RBC)数目、血红蛋白(Hb)水平、白细胞(WBC)数目和嗜中性粒细胞(Neu)数目。

科学家发现,血糖水平大于7.8毫摩尔/升且白细胞数目多于14 × 109/升的患者NT-proBNP水平显著升高。无并发症的手足口病患者NT-proBNP值远低于死亡或有并发症的患者。科研小组能够用NT-proBNP区分患者是否有脑干脑炎、肺气肿、肺溢血、循环衰竭和死亡。将NT-proBNP的阈值设为1,300皮克/毫升预测严重手足口病人的死亡表现出高灵敏度和高特异性,二者分别为85%和93.5%。有严重的EV71相关手足口病且 NT-proBNP测量值大于1,300皮克/毫升的儿童总体生存率比那些NT-proBNP水平低于1,300皮克/毫升的儿童差得多。

该研究的论文发表于2016年11月3日的《国际传染病杂志》(International Journal of Infectious Diseases)。作者总结说,有了白细胞计数和血糖水平,NT-proBNP水平能反映EV71相关手足口病的严重程度,NT-proBNP这一生物标记物似乎能比白细胞数目和高血糖血症更好地区分有严重并发症和无严重并发症的严重手足口病患者。NT-proBNP水平也许能预测重症监护室里严重EV71相关手足口病患儿的并发症或死亡。

Related Links:
湖南儿童医院
生物梅里埃
Sysmex公司


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