NT-pro-BNP在儿童呼吸窘迫综合征中的早期诊断、严重程度评估及预后预测价值

Value of NT-pro-BNP in the Early Diagnosis, Severity Assessment, and Prognostic Prediction of Pediatric Respiratory Distress Syndrome

摘要: 目的：探讨血浆N末端脑钠素原(NT-pro-BNP)在儿童急性呼吸窘迫综合征(PARDS)早期诊断、严重程度评估及预后预测中的临床价值。方法：选取2019年1月1日至2024年12月31日湘西自治州人民医院PICU收治的53例PARDS患儿作为观察组，43例重症肺炎(非PARDS)患儿作为对照组。比较两组入院时及确诊时血浆NT-pro-BNP水平，以及氧合指数(P/F)、小儿危重病例评分(PCIS)及住院时间(LOS)，并进行相关性、中介效应、亚组分析及预测模型构建。结果：观察组NT-pro-BNP水平显著高于对照组(均P < 0.001)，其PCIS评分、P/F比值更低，LOS更长(均P < 0.05)；确诊时NT-pro-BNP水平与PCIS评分(r = −0.413)、P/F比值(r = −0.470)均呈显著负相关(均P < 0.001)。中介效应分析显示，分组对NT-pro-BNP水平的总效应为3004.63，组间56.6%的NT-pro-BNP差异由有创通气、年龄介导，其中有创通气占总效应的47.7%，为主要路径。整合NT-pro-BNP等指标构建的多变量联合诊断模型AUC达0.947，具有较高诊断效能。结论：血浆NT-pro-BNP可作为PARDS早期诊断及严重程度评估的候选生物标志物。联合NT-pro-BNP构建的多变量模型显示出早期识别高危患儿的潜力，后续前瞻性、多中心研究可进一步验证其预测性能及临床应用价值。

Abstract: Objective: To investigate the clinical value of plasma N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in the early diagnosis, severity assessment and prognostic prediction of pediatric acute respiratory distress syndrome (PARDS). Methods: A total of 53 children with PARDS admitted to the Pediatric Intensive Care Unit (PICU) of Xiangxi Autonomous Prefecture People’s Hospital from January 1, 2019, to December 31, 2024, were enrolled as the observation group, and 43 children with severe pneumonia (non-PARDS) were selected as the control group. Plasma NT-pro-BNP levels at admission and at diagnosis, oxygenation index (P/F ratio), Pediatric Critical Illness Score (PCIS), and length of hospital stay (LOS) were compared between the two groups. Correlation analysis, mediation effect analysis, subgroup analysis, and predictive model construction were performed. Results: The NT-pro-BNP level in the observation group was significantly higher than that in the control group (all P < 0.001), while the PCIS and P/F ratio were lower, and the LOS was longer (all P < 0.05). At diagnosis, NT-pro-BNP level was significantly negatively correlated with PCIS (r = −0.413) and P/F ratio (r = −0.470) (all P < 0.001). Mediation effect analysis showed that the total effect of grouping on NT-pro-BNP level was 3004.63, and 56.6% of the intergroup difference in NT-pro-BNP was mediated by invasive ventilation and age, among which invasive ventilation accounted for 47.7% of the total effect as the main pathway. The multivariate combined diagnostic model integrating NT-pro-BNP and other indicators achieved an area under the curve (AUC) of 0.947, showing high diagnostic efficiency. Conclusion: Plasma NT-pro-BNP may serve as a candidate biomarker for early diagnosis and severity assessment of PARDS. An NT-pro-BNP-based multivariable model showed potential for identifying high-risk children, warranting validation of its predictive performance and clinical utility in prospective multicenter studies.