Ⅲ度房室传导阻滞患者行VVI及DDD起搏后心功能及超敏C反应蛋白的比较  

Comparison of cardiac function,NT-pro BNP and hypersensitive C-reactive protein for patients with complete atrioventricular block in different pacing mode

作　　者：黄瑞娜[1] 吴铿[1] 李腾[1] 李上海[1] 游琼[1] 莫海亮[1] 

机构地区：[1]广东医学院附属医院心血管内科,广东湛江524001

出　　处：《中国心脏起搏与心电生理杂志》2015年第6期547-550,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的比较Ⅲ度房室传导阻滞(AVB)患者行VVI及DDD起搏后心功能、N-末端B型脑钠肽(NT-pro BNP)及超敏C反应蛋白(hs-CRP)的变化。方法选取Ⅲ度AVB患者50例,按起搏方式分组。VVI组(n=25)植入单腔起搏器,起搏模式为VVI;DDD组(n=25)植入双腔起搏器,起搏模式为DDD。随访3年,比较患者起搏参数、左房内径(LAD)、左室舒张末径(LVEDD)、左室射血分数(LVEF)、左室舒张功能(E/A)、心脏指数(CI)、每搏输出量(SV)、右室内径(RV)、hs-CRP、NT-pro BNP等指标。结果两组心室电极感知、阈值、阻抗、右室起搏比例均无差异。术后LAD、LVEDD进行性扩大,LVEF进行性下降,CI较前改善,均以VVI组较为明显;SV指标VVI组术后逐年下降,而DDD组术后1年明显增加,随后下降。术后hs-CRP、NT-pro BNP进行性升高,均以VVI组较为明显。患者hs-CRP与LVEDD、LAD、NT-pro BNP之间、NT-pro BNP与LVEDD间存在正相关关系,hs-CRP、NT-pro BNP与LVEF间存在负相关关系。结论Ⅲ度AVB患者长期VVI及DDD起搏将不同程度导致心功能恶化,VVI起搏为甚,起搏术后心功能恶化与炎症反应可能有关。Objective Evaluate long-term effects of cardiac function, N-terminal pronatriuretic peptide （NT-proBNP） protein and hypersensitive C-reactive protein（ hs -CRP）about complete atrioventricular block patients with different pacing mode. Methods Fifty patients with complete atrioventricular block in our hospital were randomly divided into group VVI （n = 25） and group DDD （n=25 ）, group VVI were implanted single chamber pacemaker with pacing mode VVI, group DDD were implanted dual-chamber pacemaker with pacing mode DDD. Two groups were followed for 3 years to compare pacing parameters, left atrial diameter （ LAD）, left ventricular end-diastolic diameter （ LVEDD）, left ventricular ejection fraction （ LVEF）, left ventricular diastolic function （ E / A）, cardiac index （ CI）, right ventricular diameter （RV） ,stroke volume （SV）, hs -CRP, NT-proBNP. Results Ventricular electrode sensing threshold, impedance, the ratio of right ventricular pacing, E / A were not statistically significant between the two groups. The LAD, LVEDD in both group expansioned progressively, LYEF declined progressively, CI improved previously and group VVI were more obvious. SV index in group VVI declined, while that significantly increased in group DDD in 1 year, and then decreased; hs-CRP,NT-proBNP in both groups increased progressively, and group VVI were more obvious. There were positive correlation among Hs-CRP and LVEDD, LAD, NT-proBNP; NT-proBNP and LVEDD, hs-CRP, there were negative correlation among hs-CRP, NT- proBNP and LVEF. Conclusion DDD pacemaker and VVI pacemaker which complete atrioventricular block patients implanted will result in varying degrees of deterioration of heart function with long-term use, and VVI pacemaker significantly . Pacing deterioration of cardiac function may be related with inflammation. [ Chinese Journal of Cardiac Pacing and Electrophysiology, 2015,29 （ 6 ） ：547-550 ]

关 键 词：心血管病学 心脏起搏器 Ⅲ度房室传导阻滞 心功能 N-末端B型脑钠肽 超敏C反应蛋白 

分 类 号：R318.11[医药卫生—生物医学工程] R541.76[医药卫生—基础医学]