摘要
目的探讨永久性人工心脏起搏器的植入、起搏方式以及心室起搏百分比对患者血浆氨基末端脑利钠肽原（NT-proBNP）水平的影响及其临床意义。方法76例永久性人工心脏起搏器植入患者作为起搏组，71例性别及年龄匹配的非人工心脏起搏器植入患者作为对照组，比较两组间、起搏组组内不同起搏模式、起搏组组内不同心室累积起搏百分比、起搏器参数调整前后患者血浆NT—proBNP水平的差异。结果与对照组相比，永久性人工心脏起搏器组患者血浆NT-proBNP水平显著升高（P〈0．01）；其中，VVI亚组患者血浆NT—proBNP水平明显高于DDD亚组（P〈0．05），累积心室起搏百分数〉40％的患者血浆NT—proBNP水平明显高于累积心室起搏百分数〈40％的患者（P〈0．05）；对于累积心室起搏百分数〉40％的患者行起搏器参数调整，减少心室起搏后，血浆NT—proBNP水平明显下降。结论作为心功能不全及不良预后的敏感指标，血浆NT—proBNP可反映永久性人工心脏起搏器对于患者心功能及其预后的影响，进而指导临床。
Objective： To explore the effect and the clinical significance of serum NT-proBNP concentration in patients implanted with permanent artificial heart pacemakers. Methods： 76 patients implanted with permanent artificial heart pacemakers were continuously collected as the experimental group. The control group was consisted of 71 patients without a permanent artificial heart pacemaker, which were matched with the experimental group in age and gender. Blood NT-proBNP concentration was compared between two groups and within the sub-groups of different operating modes and cumulative ventricular pace-making percentage. Results： The experimental group has a much higher level of NT-proBNP than the control group （507.3 ±-196.9ng/L vs 267.1 ±113.1 ng/L ） （ P〈0.01 ） . VVI sub-group shows higher level of NT-proBNP than DDD sub-group （632.6±223.1ng/L vs 368.0± 135.8 ng/L ） （P〈0.05） . Accumulative ventricular pace-making percentage above 40% leads to higher level of NT-proBNP than that below 40% （742.1 ±235.5ng/L vs 327.1±105.0 ng/L ） （P〈0.05） . Reduction of accumulative ventricular pace-making percentage leads to decrease in serum NT-proBNP concentration （742.1 ±235.5ng/L vs 582.1 ±196.6） （P〈0.05） . Conclusions： As a sensitive indicator of heart failure and poor prognosis, serum NT-proBNP concentration may reflect the influence of permanent artificial heart pacemakers on heart function, which could guide clinical practice.
