血清肌酐水平对心脏再同步化治疗患者预后的影响

Effect of serum creatinine on efficacy and prognosis of cardiac resynchronization therapy

目的探讨心脏再同步化治疗（CRT）术前患者血清肌酐（SCr）水平与CRT疗效的关系。方法91例心力衰竭（简称心衰）患者根据术前SCr定量分为3组，I组：33例（sCr≤1．0mg／d1），II组：35例（1．0mg／dl〈SCr≤1．5mg／d1），III组：23例（1．5mg／dl〈SCr≤2．5mg／dl）。比较3组CRT植入前及植入后6，12个月的NYHA心功能、6min步行距离（6-MWT）、左室舒张末期内径（LVEDD）、左室射血分数（LVEF）及死亡率。结果①病死率：I组6例死亡（占18．18％），无因心衰恶化死亡。Ⅱ组7例死亡（占20％），心衰恶化1例。Ⅲ组8例死亡（占34．78％），心衰恶化4例。④D功能：各组术后6，12个月心功能均较术前明显改善（P〈0．01）。③6-MWT：I组和Ⅱ组术后6，12个月较术前明显增加（P〈0．01），Ⅲ组术后12个月较术前增加不明显（P〉0．05）。@LYEDD：I组术后6，12个月较术前明显减小（P〈0．05～0．01），Ⅱ组和Ⅲ组术后较术前无明显减小（P〉0．05）。⑤LVEF：I组和Ⅱ组术后较术前明显增加（P〈0．01），Ⅲ组术后LVEF较术前亦明显增加（P〈0．05），组间比较有明显差异（P〈0．05）。结论患者术前SCr水平可影响CRT的疗效，术前SCr水平越高，术后患者临床及心功能指标恢复越差。

Objective To assess the influence of the level of serum creatinine （SCr） before implantation on the prognosis of patients with cardiac resynchronization therapy （CRT）. Methods Ninty-one patients with heart failure were divided into three groups（ Group I ： SCr≤〈1.0mg/dl, n=33; Group II： 1.1 mg/dl 〈 SCr ≤1.5 mg/dl, n=35; Group Ill ： 1.5 mg/dl 〈 SCr ~〈 2.5 mg/dl, n = 23 ）. Results There were 6 patients （ 18.18% ） died in Group I and 7 （20%） died in Group II and 8（34.78% ） died in Group III. The heart function improved significantly after 6 and 12 months of operation in 3 groups（ P 〈 0.01 ）. 6-minute hall-walking test increased significantly in Group I and Group II（ P 〈 0. 01 ）and did not increase sigfificantly in Group IH （P 〉 O. 05 ）at 6 - 12 months of postoperation. Left ventricular end-diastolic dimension diminished significantly at the 6 - 12 month follow-up in Group I （P 〈0.05 -0.01 ） and did not decrease obviously in Group II and III （ P 〉0.05 ）. Left vcntricular ejection fraction increased significantly in 3 Groups （ P 〈0.05 -0.01 ）. There was significantly statistical difference in 3 Groups. Conclusion The higher level SCr （ 〉 1.5 mg/dl） before implantation predicts worse left ventricular remodeling and the increase of patients＇ mortality from heart failure aggravation after CRT implantation.