目的　探讨重症肺炎合并心力衰竭患儿血清肌酸激酶同工酶(CK-MB)、脑利钠肽(BNP)和神经肽Y(NPY)水平的变化。方法　入选2010年12月至2014年12月住院普通肺炎患儿32例(普通组)，重症肺炎患儿20例(重症组)，重症肺炎合并心力衰竭患儿36例(心衰组)，以及健康体检儿童26例(对照组)，采用酶速率法在ADVIA1650全自动生化分析上测定CK-MB，酶联免疫吸附试验(ELISA)方法检测BNP及NPY的水平，其中18例重症肺炎合并心力衰竭患儿在恢复期再次检测。结果　四组间血清CK-MB、BNP和NPY水平比较，差异均有统计学意义(F=25.19~277.94，P均<0.01)。心衰组患儿血清CK-MB、BNP和NPY浓度均高于重症组、普通组和对照组，差异有统计学意义(P均<0.05)；重症组血清CK-MB浓度高于普通组和对照组，差异有统计学意义(P均<0.05)；普通组与对照组CK-MB浓度比较差异无统计学意义(P>0.05)；重症组、普通组和对照组三组间血清BNP和NPY浓度比较，差异均无统计学意义(P均>0.05)。心衰组18例患儿治疗后的血清CK-MB、BNP和NPY水平均低于治疗前，差异有统计学意义(P均<0.001)。心衰组血清BNP水平与CKMB、NPY水平均呈显著正相关(r=0.681、0.525，P均<0.01)；NPY与CK-MB水平亦呈显著正相关(r=0.545，P<0.01)。结论　血清CK-MB、BNP及NPY浓度检测有助于诊断儿童重症肺炎合并心衰，其中BNP更为敏感。

Objective To investigate the levels of creatine kinase (CK-MB), brain natriuretic peptide (BNP), and neuropeptide Y (NPY) in severe pneumonia pediatric patients combined with heart failure (HF). Methods Pneumonia pediatric patients admitted from December 2010 to December 2014 had been enrolled and divided into pneumonia group (P) (n=32), severe pneumonia group (SP) (n=20) and severe pneumonia combined HF group (HF) (n=36). Twenty healthy children served as control group (C). Serum level of CK-MB was detected by enzyme rate method and were measured by ELISA. BNP and NPY were measured again during the recovery period in 18 cases in HF group. Results The serum levels of CK-MB, BNP and NPY were significantly different among the four groups, (F=25.19 ~ 277.94, P <0.01). The serum levels of CK-MB, BNP and NPY were significantly higher in HF group than in SP, P and C group (P<0.05). The serum level of CK-MB was significantly higher in SP group than that in P and C group (P <0.05) and there was no difference between P and C group (P>0.05). The serum levels of BNP and NPY were not statistically significant between SP and P and C group (all P> 0.05). In HF group, the serum levels of CK-MB, BNP, and NPY were significantly decreased in 18 cases after treatment. The serum level of BNP was positively correlated with CK-MB and NPY (r = 0.681, 0.525, all P<0.01) and the NPY and CK-MB levels were also positively correlated (r=0.545, P <0.01). Conclusions The Detection of the serum levels of CK-MB, BNP and NPY can help diagnose severe pneumonia combined with HF. The BNP maybe the most sensitive indicator.