Clinical Application Value Of NT-proBNP Combined With Lac And Myocardial Enzyme In Children With Severe Pneumonia Complicated With Heart Failure

Objective: To investigate the application value of clinical indexes such as N-terminal pro B-type natriuretic peptide（NT-pro BNP）,Lacic Acid（Lac）and myocardial enzymes in patients with severe pneumonia complicated with congestive heart failure.To provide basis for early prediction of severe pneumonia complicated with heart failure in children and improvement of diagnosis and treatment effect.Methods:60 children with severe pneumonia with congestive heart failure and 60 children with severe pneumonia without congestive heart failure were randomly selected.Clinical data were recorded,medical history was inquired,relevant physical examination was performed,and ROSS score was improved.The values of NT-pro BNP and Lac,arterial blood gas analysis,creatine kinase（CK）,creatine kinase MB isoenzyme（CK-MB）,electrocardiogram,X-ray and cardiac color ultrasound were detected.SPSS27.0 software was used to process and analyze the collected data.P=0.05 was used as the test standard,and P<0.05 was considered statistically significant.Results:1.There were 39 males（65.0%）and 21 females（35.0%）in the severe pneumonia group without heart failure,with an average age of 4.5（2.0,14.75）.There were 43males（71.7%）and 17 females（28.3%）in the group with heart failure,with an average age of8.0（3.25,34.25）.There was no significant difference in gender composition between the two groups（₂=0.616,P=0.556）,and no significant difference in age（Z=-1.719,P=0.086）.2.The average levels of CK,CK-MB and LDH in severe pneumonia group without heart failure were 95.0（56.8,143.0）,29.5（29.5,39.9）and 333.0（267.3,397.3）,respectively.There were262.5（129.5,668.0）,89.3（67.5,151.8）and 548.0（346.0,802.3）in the group with heart failure.There were significant differences in CK,CK-MB and LDH between the two groups（Z=6.241,P < 0.05;Z=8.256,P < 0.05;Z=4.653,P < 0.05）;3.The average level of NT-pro BNP and Lac in the severe pneumonia group without heart failure was 172.4（93.93,319.08）,7.90（7.90±3.48）,and 453.2（330.6,1088.1）,9.40（9.40±4.26）in the group with heart failure.The difference was statistically significant,and the statistical values were（Z=6.430,P < 0.05;t=2.112,P<0.05）;4.NT-pro BNP,CK,CK-MB,LDH are Spearman correlation analysis,indicating that the relationship between NT-pro BNP and Lac is r=0.210,p=0.021,NT-pro BNP and CK is r=0.025,p=0.783;It is positively correlated with CK-MB（r=0.064,p=0.488）and LDH（r=0.146,p=0.112）.5.Lac,CK,CK-MB,NT-pro BNP are risk factors of severe pneumonia combined with heart failure.When NT-pro BNP takes234.95ng/L,it is the best predictive value,at this time the sensitivity and specificity are 91.7%,73.3%,CK takes 187.5U/L,it is the best predictive value,at this time the sensitivity and specificity are 65.0%,90.0%.Conclusion:1.Children with severe pneumonia combined with heart failure are more likely to cause acidosis than children without heart failure;2.NT-pro BNP is positively correlated with Lac,CK,CK-MB,LDH,while Lac is not correlated with CK,CK-MB,LDH;3.NT-pro BNP,CK,CK-MB for the early prediction of severe pneumonia with heart failure has an important reference value,when CK-MB≥50.3U/L,CK≥187.5U/L,NT-pro BNP≥234.95ng/L,suggesting that children with heart failure is more likely,It can be used as an important laboratory indicator for early identification of severe pneumonia complicated with heart failure.