窄QRS波心衰病人心脏再同步化治疗疗效分析

摘要

目的 分析窄QRS波心衰病人心脏再同步化治疗(CRT)的疗效.方法 入选2010年9月—2015年9月就诊于内蒙古医科大学附属医院急诊内科的心衰病人作为病例组(n=57),分为两组,A组为心衰合并宽QRS波并植入CRT治疗组(n=46);B组为心衰并窄QRS波病人,实时三维超声心动图确定存在心脏运动不同步,植入CRT治疗组(n=11);选取45名同期于我院体检的正常人设为对照组(C组,n=45).术前及术后3个月均行心电图、实时三维超声心动图及N末端脑钠肽原(NT-proBNP)、高敏C反应蛋白(hs-CRP)、明尼苏达心力衰竭生活质量调查表评分(Minnesota score)、6 min步行试验(6MWT)检查,评估心功能,记录相关数据.结果 术前各组间年龄、心率、体重指数,病例组组间用药情况、伴随疾病等比较,差异无统计学意义(P>0.05);病例组心功能、纽约心脏病协会(NYHA)分级、明尼苏达心力衰竭生活质量调查表评分、6MWT、左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、血清NT-proBNP以及hs-CRP水平,与C组比较均明显升高,差异均有统计学意义(P<0.05);A、B两组间比较,差异无统计学意义(P>0.05).与术前比较,A组、B组术后3个月心功能NYHA分级、Minnesota score、6MWT、LVEF、LVEDV、LVESV、不同步指标、血清NT-proBNP、hs-CRP水平比较,差异有统计学意义(P<0.05或P<0.01),但两组术后3个月各指标比较差异无统计学意义(P>0.05).结论 实时三维超声心动图作为一种无创、安全可靠、可重复性强的检测手段,是评估心脏收缩同步化的可靠方法.NT-proBNP、hs-CRP等指标其血清水平随容量或压力负荷增加而升高,与左室重构、心功能不全的发生、发展和转归相关,因此,它们在一定程度上可以反映心衰的严重性及危险程度,并预测CRT术后疗效.使用心脏超声新技术结合NT-proBNP、hs-CRP为临床医生在CRT术前筛选合适病人,能够提高CRT疗效,并且使左室不同步的窄QRS波心衰病人,亦可通过CRT治疗获益.%Objective To observe the efficacy of cardiac resynchronization therapy (CRT)in heart failure (HF)patients with narrow QRS wave. Methods Fifty-seven patients with HF were selected from September 2010 to September 2015 and divided into group A (QRS≥120 ms,n=46)and group B (QRS<120 ms,n=11)according to the QRS time.They were treated with CRT. Forty-five healthy individuals were as the controls (group C).The real-time three-dimensional echocardiography (RT-3DE),electrocardio-gram (ECG)were analyzed before and after 3 months of CRT.The levels of plasma N-terminal pro-brain natriuretic peptide (NT- proBNP), high sensitivity C-reactive protein (hs-CRP)were observed. The left ventricular ejection fraction (LVEF),left ventricular end-di-astolicolume (LVEDV),end-systolic volume (LVESV),systolic synchronicity parameters,systolic synchronicity parameters,6 mi-nutes walk test (6MWT)were evaluated. Results Before operation,al the indexes such as cardiac function NYHA classification, Minnesota scores,6MWT,and LVEF,LVEDV,LVESV,heart movement synchronization index,plasma NT-proBNP and hs-CRP lev-els in group A and group B were significantly increased compared with group C (P<0.05 or P<0.01). There was no difference be-tween group A and group B (P>0.05). After 3 months of operation,there was difference in cardiac function NYHA classification, Minnesota scores,6 MWT,and LVEF,LVEDV,LVESV,heart movement synchronization index,plasma NT-proBNP and hs-CRP levels in group A and group B compared with before operation(P<0.05). There was no significant difference in the indexes between group A and group B after 3 months of operation (P>0.05). Conclusion Real-time three-dimensional echocardiography as a noninvasive,safe and reliable,strong repeatability of the testing means,is a reliable method in evaluating cardiac systolic synchroni-zation. The levels of plasma concentration of NT-proBNP and hs- CRP rise,with the increase of volume or pressure load,and relat-ed to left ventricular remodeling and cardiac insufficiency of occurrence,development and the outcome,they can reflect the severity of heart failure and dangerous degree,and predict postoperative effect of CRT. Use of RT-3DE combined with the NT–proBNP and hs-CRP can screening suitable patients for clinicians in CRT,can improve the CRT curative effect,and HF patients with narrow QRS wave and left ventricular asynchronous can also benefit by CRT.