扩张型心肌病双心室同步化起搏前后血清前胶原端肽的变化及临床意义

Changes of serum pro-collagen peptides in dilated cardiornyopathy before and after cardiac resynchronization therapy

目的 探讨扩张型心肌病患者双心室同步化起搏（CRT）前后血清I型前胶原端肽（PⅠCP）和Ⅲ型前胶原端肽（PⅢNP）的变化以及CRT植入与前胶原端肽的相关性.方法 将行CRT植入的40例扩张型心肌病患者,根据随访半年的左室射血分数（LVEF）结果分为CRT应答组（20例）和CRT无应答组（20例）.分别检测比较两组患者术前及术后半年LVEF、左室舒张末期内径（LVEDd）及PⅠCP、PⅢNP的浓度.结果 与术前比较,CRT应答组患者术后半年LVEF明显升高（P＜0.05）,LVEDd及PⅠCP、PⅢNP均明显下降（均P＜0.05）;而CRT无应答组手术前后各观察指标均未发生明显变化（P ＞0.05）.结论 CRT植入能明显降低应答者PⅠCP、PⅢNP浓度,可能可以改善扩张型心肌病患者心肌纤维化程度,是此类患者药物治疗外改善预后的强有力治疗手段之一.

Objective To investigate the changes of serum procollagen type I carboxy-terminal peptide （PICP）and pro- collagen type III N-terminal peptides （P III NP）before and after cardiac resynchronization therapy （CRT） pacemaker in patients with dilated cardiomyopathy （DCM）. Methods Forty patients with dilated cardiomyopathy receiving cardiac resynchronization therapy were categorized as responders or nonresponders, according to LVEF and LVIDd levels 6 months after CRT. Serum levels of PICP and P Ⅲ NP were measured at baseline and 6 months after CRT. Results Serum levels of PICP and PⅢNP in responders at 6 months after CRT were lower than baseline levels （P〈0.05},serum levels of PICP and PⅢNP in nonresponders at 6 months after CRT were higher than baseline levels （P 〉0.05）. Conclusion Results indicate that effective CRT may inhibit the myocardial fibrosis in DCM patients.