右室不同部位起搏对左室重构及脑钠肽的影响

Influence of different right ventricular pacing sites on left ventricular remodeling and brain natriuretic peptide

目的 比较右室流出道间隔部（RVS）与右室心尖部（RVA）起搏对左室重构及脑钠肽的影响.方法 60例具备起搏器植入指征的患者,随机分为RVA组与RVS组,分别于治疗前及治疗后6、12、24个月采血应用夹心酶联免疫吸附法检测血浆脑钠肽（BNP）水平,超声测量左心室舒张末期内径（LVEDD）、左室舒张末期容积（INEDV）和左室射血分数（LVEF）,观察2组患者起搏前后心室重构指标及BNP的变化.结果 RVA组起搏术后各个时间点BNP水平显著升高[术后6、12、24个月分别为（108.2±29.8）、（190.3±46.7）、（308.2±56.5）ng/L],与术前[（60.2±15.7）ng/L]比较差异均有统计学意义（P均〈0.05） RVS组起搏术后仅24个月时BNP水平较术前升高[（75.2±15.8）ng/L与（63.9±15.1）ng/L],差异有统计学意义（P〈0.05）.RVA起搏组随着起搏时间的延长,与术前相比,12个月时LVEDD、LVEDV增加,LVEF下降,差异均有统计学意义（P均〈0.05）.而RVS组LVEDD无明显增大,LVEDV轻度增加,LVEF呈下降趋势,差异均无统计学意义（P均〉0.05）.结论 RVS起搏较RVA起搏能改善心肌重构,改善左室功能.减轻神经内分泌激活.

Objective To evaluate the influence of right ventricular outflow tract septal （ RVS） pacing with right ventricular apical （ RVA） pacing on left ventricular remodeling and brain natriuretic peptide （ BNP）. Methods Sixty patients with indication of pacemaker implantation were randomized into two groups, RVA group and RVS group. BNP was measured with ELISA, and echocardiography was performed to measure the left ventricular end diastolic volume （ LVEDD）, left ventricular end systolic volume （ LVEDV） and left ventricular ejection fraction （LVEF） at pre-operation,and after 6,12,24 months pacing. The difference of cardiac remodeling and BNP in the two groups was observed. Results Compared to BNP at pre-operation （（ 60. 2 ± 15. 7 ） ng/L） , BNP increased significantly in the RVA group at the 6th,12th and 24th month after operation（ （ 108. 2 ±29. 8） , （ 190. 3 ±46. 7） ,（308. 2 ±56. 5）ng/L,respectively） （P 〈0. 05）. In the RVS group,BNP increased only at 24 months after pacing （ （75. 2 ± 15. 8） ng/L vs. （63. 9 ± 15. 1 ） ng/L） （P 〈 0. 05）. There was significant difference on BNP between the two groups. LVEDD,LVEDV increased,LVEF declined at 12 months after pacing in the RVA group,which were not observed in the RVS group. There was significant difference on LVEDD,LVEDV and LVEF in the RVA group （P〈 0. 05） between the 12th month and pre-operation,and there were no significant difference in the RVS group （P 〉 0. 05）. Conclusions Compared to RVA pacing,RVS pacing was more beneficial to improve heart function,prevent cardiac remodeling and decline the activation of nerve-endocrine.