心脏再同步治疗对心肌纤维化的影响

Effects of cardiac resynchronization therapy on serum concentration of P-Ⅰ NP,P-Ⅲ CP and Ⅳ-C

目的本文通过观察心肌病患者CRT手术前后Ⅰ型前胶原氨端肽(P-ⅠNP)、Ⅲ型前胶原羧基端肽(P-ⅢCP)和Ⅳ型胶原(Ⅳ-C)的血清浓度的变化以及与心衰的关系,初步探讨其与CRT对心肌纤维化的影响。方法选择2009年1月～2009年8月行CRT的患者(CRT组),另选择与上述患者同期住院年龄相近的患者作为对照组。记录患者病程、心脏超声指标等基线情况。共入选符合标准的患者40例,其中CRT组和对照组各20例。随访6个月,主要终点为因心力衰竭而住院,6个月内无心衰住院者作为CRT1组,出现心衰住院者作为CRT2组。采用放免法检测所有患者术前、术后1月、3月和6月血清标本中P-ⅠNP,P-ⅢCP以及Ⅳ-C的浓度。结果 P-ⅠNP、P-ⅢCP以及Ⅳ-C血清浓度与左室舒张末期内径、病程长短成正相关,与左室射血分数呈负相关。CRT组患者术后P-ⅠNP、P-ⅢCP以及Ⅳ-C血清浓度呈逐渐下降的趋势,一直持续至术后6月,差异有统计学意义(p<0.05);对照组在随访期间无显著变化。为期半年的随访表明,出现心衰再住院的CRT患者P-ⅠNP、P-ⅢCP以及Ⅳ-C血清浓度显著高于未出现心衰者。结论心肌病患者P-ⅠNP、P-ⅢCP以及Ⅳ-C血清浓度与心衰的严重程度相关,CRT可显著降低其水平,并可反映CRT疗效。

Objective To explore the relation between procollagen typeⅠprocollagen N-Terminal Peptide（P-ⅠNP）,type Ⅲprocollagen N-Terminal Peptide（P-ⅢNP）,Ⅳ collagen（Ⅳ-C） and effects of cardiac resynchronization therapy（CRT） by observing serum concentration of P-ⅠNP,P-ⅢNP and Ⅳ-C before and after operation in patients with cardiac resynchronization therapy（CRT）,and its relationship with heart failure.Methods From January to August in 2009,patients with CRT（CRT group） and diagnosed with cardiomyopathy（control） were enrolled.Baseline characters as time course of heart failure,echocardiographic parameters were recorded.The main endpoint was heart-failure hospitalization in the 6 months follow-up.Patiens were divided into CRT1 group with heart-failure hospitalization and CRT2 group without.Serum concentration of P-ⅠNP,P-ⅢNP,and Ⅳ-C were detected by radioimmunoassay before,1,3 and 6 months after CRT.Results 40 patients were enrolled,20 of them were in CRT group.Serum concentration of P-ⅠNP,P-ⅢNP,and Ⅳ-C were positive correlation with LVEDD and time course of heart failure,negative correlation with LVEF.Concentration of serum P-ⅠNP,P-ⅢNP,and Ⅳ-C decreased significantly gradually after operation until 6 months in CRT group（p0.05）,there was no significant difference in control.Patients with heart-failure hospitalization had significant higher serum concentration of P-ⅠNP,P-ⅢNP,and Ⅳ-C than patients without in the follow-up.Conclusions Concentration of serum P-ⅠNP,P-ⅢNP,and Ⅳ-C were significant correlation with the severity of heart failure,CRT could decrease them remarkably.They may be one of the predictors of clinical effects of CRT.