心脏再同步治疗慢性心力衰竭的疗效与血浆脑钠肽的关系  

The relationship of clinical effects of biventricular pacing therapy and the plasma brain natriuretic peptide in patients with congestive heart failure

作　　者：何建桂[1] 陈胜龙[1] 马虹[1] 董吁钢[1] 唐安丽[1] 吴素华[1] 柳俊[1] 

机构地区：[1]中山大学附属第一医院心内科,广州 510080

出　　处：《中华心律失常学杂志》2009年第1期30-33,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的观察心脏再同步治疗（CRT）慢性心力衰竭（CHF）的疗效与血浆脑钠肽（BNP）的关系。方法21例CHF合并室内阻滞患者行CRT，其中5例植入心脏再同步治疗除颤器（CRT—D），包括2例心力衰竭合并心房颤动患者接受房室结射频消融术＋CRT—D治疗。观察植入术前及术后3个月、1、2年的心功能（NYHA分级）、左心室收缩末内径（LVESD）、左心室舒张末内径（LVEDD）、左心室射血分数（LVEF）、BNP水平。结果21例患者中的16例存活患者于植入CRT后心功能明显改善，心功能从Ⅲ～Ⅳ级改善为Ⅱ～Ⅲ级（P〈0．05）；LVEDD、LVESD、LVEF均明显改善（P〈0．05）；血浆BNP均明显降低（P〈0．01）。5例死亡患者以上指标无改善。植入CRT前血浆BNP水平小于3000pg／ml者（BNP—L组）与人于3000pg／ml者（BNP—H组）相比，CRT治疗3个月时两组LVEDD、LVESD、LVEF均明显改善（P〈0．05），但12个月时BNP—I。组的心功能指标仍进一步改善，而BNP—H组与CRT治疗前的心功能指标相比差异无统计学意义（P〉0．05）。在随访的24个月内，BNP—L组中只有1例因心功能恶化死亡；而BNP—H组中有3例因心功能恶化死亡，1例为心脏性猝死。结论植入CRT后心功能指标在早期即得到改善的患者，其2年预后较好；植入CRT前血浆BNP水平可反映植入CRT后的心功能变化趋势；植入CRT后3个月时BNP水平不下降的患者其预后较差。Objective To observe the relationship of clinical effects and the plasma brain natriuretic peptide（BNP） in patients with chronic heart failure who were implanted cardiac resynehronization therapy （CRT）. Methods Twenty-one patients with congestive heart failure and intro-ventricular block received biventricular resynchronous pacing. Five patients received cardiac resynchronizaton-defibrillator （CRT-D）. Among them 2 patients with chronic atrial fibrillation received atrio-ventficular node radiofrequeney ablation be- sides CRT-D. The NYHA class, LVEDD/LVESD, LVEF, BNP level were evaluated before the pacemaker im- plantation as well as follow-up at 3-month, 12-month and 24-month ＇after implantation. Results Among all the 21 patients,16 survived. In these 16 patients,the NYHA class was improved from class Ⅲ -Ⅳ to class Ⅱ～Ⅲ（ P 〈 0. 05 ）, the LVEDD, LVESD, LVEF were significantly improved （ P 〈 0.05 ） and the plasma BNP level decreased significantly （P 〈 0. 01 ） ,after implantation. However, the parameters mentioned above did not signif- icantly changed after implantation in remained 5 patients who died during follow-up. According to the plasma BNP level before CRT implantation, the 21 patients were divided into two groups： the BNP-H group with plasma BNP level more than 3000 pg/ml and the BNP-L group with plasma BNP level lower than 3000 pg/ml. LVEDD, LVESD, LVEF were significantly improved at 3-month ＇after implantation than those betore implantation in both groups （P 〈 0.05 ）. Nevertheless, at 12-month follow-up, the above parameters in BNP-L group were fur- ther improved but did not changed in BNP-H group when compared with those obtained before CRT implantation. During follow-up of 24 months, there was only 1 death dued to heart function aggravation in BNP-L group, while there were 4 deaths in BNP-H group,including 3 dued to heart function aggravation and 1 dued to sudden cardiac death. Conclusions Those patients whose heart function was improved at 3-month follow

关 键 词：慢性心力衰竭 心脏再同步治疗 血浆脑钠肽 

分 类 号：R541[医药卫生—心血管疾病]