右室不同部位起搏对血浆IL-6、ANP水平和左心功能的影响

The influence of cardiac pacemaker implantation site on plasma interleukin-6,atrial natriuretic peptide and left ventricular function

目的:通过比较右心室心尖部(RVA)和右心室中位间隔部(mid-RVS)两种不同部位起搏早期对患者血浆白细胞介素-6(IL-6)、血浆心房利钠肽(ANP)水平和左心功能的影响,探讨IL-6、ANP水平与无症状左心收缩功能(ALVD)不全的相关性。方法:将42例植入DDD型起搏器患者随机分为RVA起搏组、mid-RVS起搏组,观察两组患者起搏器植入术前及术后3个月和6个月血浆IL-6、ANP水平、左房内径(LAD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)以及心电图QRS波时限的变化。结果:术前和术后3个月比较,两组患者血浆IL-6、ANP水平和LAD、LVEDD、LVEF等均无明显差异;术后6个月RVA起搏组血浆IL-6、ANP水平和LAD、LVEDD较mid-RVS起搏组显著升高(P<0.01);RVA起搏组术后6个月与术前、术后3个月比较,IL-6、ANP水平和LAD、LVEDD等明显升高(P<0.05),LVEF有降低趋势。术后mid-RVS起搏组QRS波时限明显小于RVA起搏组(P<0.001)。结论:右室中间隔起搏有助于避免常规右室心尖部起搏导致的血浆IL-6和ANP水平增高以及左房、左室的扩大,可能减少心力衰竭的发生。

Objective：To investigate the influence of different cardiac pacemaker implantation site on plasma interleukin-6（IL-6）,atrial natriuretic peptide（ANP） and left ventricular systolic function.Methods：Forty-two patients with DDD pacing were randomly divided into two groups：right ventricular apex pacing group（RVA,n = 20） and middle right ventricular septum pacing group（mid-RVS,n = 22）.The plasma IL-6,ANP level,LAD,LVEDD,LVEF and QRS complex duration of pre-operation and post-operation were tested.Results：There was no statistical significance of IL-6,ANP level and LAD,LVEDD,LVEF between two groups before implantation and three months after implantation.The plasma leves of IL-6,ANP and LAD,LVEDD in RVA pacing group were higher than those in mid-RVS pacing group six months after implantation（P 〈0.01）.The plasma leves of IL-6,ANP and LAD,LVEDD in RVA pacing group six months after implantation were higher than those pre-implantation and three months after implantation（P 〈0.01）.The pacing QRS complexs duration was shorter in mid-RVS pacing group than that in RVA pacing group.Conclusion：Compared with the RVA pacing,mid-RVS pacing can avoid the elevation of IL-6,ANP level,left artial and ventricular dilation and the impairment of left ventricular systolic function.