早产儿有血流动力学意义的动脉导管未闭诊断的研究进展

Research Progress in the Diagnosis of Patent Ductus Arteriosus with Hemodynamic Significance in Premature Infants

摘要: 早产儿动脉导管未闭(PDA)的发生率与出生体重、胎龄呈负相关，尤其是胎龄 ≤ 28周的早产儿，其发生率高达50%以上。当动脉导管持续左向右分流超过机体代偿能力时，会导致一系列临床症状及体征，即早产儿有血流动力学意义的动脉导管未闭(hsPDA)。hsPDA的早产儿可能面临多种并发症，如脑室周围白质软化、坏死性小肠结肠炎、早产儿视网膜病、骨质发育不良及肾功能不全等，同时肺循环血流量增加，容易引发支气管肺发育不良、肺出血及充血性心力衰竭，严重威胁早产儿生命安全。目前，hsPDA的诊断主要依赖于超声心动图，该技术可准确评估动脉导管的通畅性、开放程度及血流方向和速度。然而，超声心动图在动态评估动脉导管血流动力学变化方面存在局限性。因此，探索生物标志物联合超声心动图对hsPDA的早期诊断和治疗显得尤为重要。本文将综述早产儿hsPDA的发病机制、临床表现、目前诊断的局限性，以及生物标志物在诊断中的研究进展，包括利钠肽家族、肌钙蛋白、血小板相关参数及新型生物标志物等方面，强调生物标志物联合超声心动图有望提高对hsPDA早期诊断的准确性。

Abstract: The incidence of patent ductus arteriosus (PDA) in preterm infants is negatively correlated with birth weight and gestational age, especially in preterm infants with gestational age ≤28 weeks, the incidence is as high as 50%. When continuous left-to-right ductus arteriosus shunt exceeds the body’s compensatory capacity, it can lead to a series of clinical symptoms and signs, namely, haemodynamically significant patent ductus arteriosus (hsPDA) in premature infants. Preterm infants with hsPDA may face a variety of complications, such as periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity, bone dysplasia and renal insufficiency, etc. At the same time, increased pulmonary circulation blood flow is likely to lead to bronchopulmonary dysplasia, pulmonary hemorrhage and congestive heart failure, which seriously threatens the life safety of preterm infants. At present, the diagnosis of hsPDA mainly relies on echocardiography, which can accurately assess the patency and openness of the ductus arteriae and the direction and velocity of blood flow. However, echocardiography has limitations in the dynamic assessment of ductus arteriosus hemodynamic changes. Therefore, it is particularly important to explore biomarkers combined with echocardiography for the early diagnosis and treatment of hsPDA. This paper reviews the pathogenesis, clinical manifestations, limitations of current diagnosis of hsPDA in premature infants, as well as the research progress of biomarkers in diagnosis, including natriuretic peptide family, troponin, platelet-related parameters and novel biomarkers. It is emphasized that biomarkers combined with echocardiography are expected to improve the accuracy of early diagnosis of hsPDA.