心脏再同步治疗对中重度慢性心力衰竭的疗效研究

Effect of Cardiac Resynchronization Therapy in Patients With Moderate to Severe Chronic Heart Failure

目的：观察心脏再同步治疗（CRT）对中重度慢性心力衰竭患者的心功能及炎症因子的影响，探讨CRT对中重度慢性心力衰竭的临床疗效。方法：选取2011-06至2012-07因心力衰竭于新疆医科大学第-附属医院心脏中心行CRT或单纯药物治疗的慢性心力衰竭患者40例，平均年龄（58．4±14．3）岁。左心室舒张末期内径≥55mm，左心室射血分数≤35％，心电图QRS≥120ms，分为CRT（CRT＋优化药物治疗龃20例，对照组（最优化药物治疗）20例。优化药物治疗包括血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂、醛固酮拮抗剂和地高辛。两组于治疗前、治疗后1个月、6个月及12个月分别测定6分钟步行距离，并通过超声心动图测量左心室射血分数、左心室舒张末期内径以及抽空腹静脉血检测肿瘤坏死因子-α、白细胞介素-6、趋化因子-1及高敏C反应蛋白浓度。结果：治疗后1个月、6个月及12个月，CRT组6分钟步行距离较治疗前改善（P〈0．05～0．01），与对照组比较，差异有统计学意义（P〈0．05—0．01）；与治疗前相比，CRT组治疗后1个月、6个月及12个月左心室射血分数明显改善（P〈0．05—0．01），与对照组相比，差异有统汁学意义（P〈0．05）；治疗1个月、6个月及12个月左心室舒张末期内径与治疗前相比显著缩小（P〈0．05—0．01），与对照组相比差异有统计学意义（P〈0．05）。另外，CRT组治疗后1个月肿瘤坏死因子-α、白细胞介素-6、趋化因子-1及高敏C反应蛋白浓度较治疗前有下降趋势（P〉0．05），但差异无统计学意义。CRT组治疗6个月及12个月后肿瘤坏死因子-α、白细胞介素-6、趋化因子-1及高敏C反应蛋白浓度与治疗前相比明显下降（P〈0．01），与对照组相比差异有统计学意义（P〈0．05）。结论：CRT有助于纠正慢性心力衰竭患者的血液动力学紊乱，使扩大的心腔缩小，提高左心室射血分数，在治疗6个月后心功能改善的同时相关炎症因子肿瘤坏死因子-α、门细胞介素-6、趋化因子-1及高敏C反应蛋闩浓度降低。

Objective： To observe the clinical efficacy of cardiac resynchronization therapy （CRT） in patients with moderate to severe chrouic heart failure （CHF） for their cardiac function and the inflammatory factor levels. Methods： A total of 40 CHF patients treated in our hospital from 2011-06 to 2013-07 were studied. The patients had the left ventricular end-diastolic dimension （LVEDD） ≥55 mm, left ventricular ejection fraction （LVEF） ≤ 35%, QRS duration ≥120 ms and the mean age at （58.4±14.3） years. The patients were divided into 2 groups, CRT group, the patients received biventricular pacing and optimal medication and Control group, the patients received only optimal medication, n=20 in each group. The 6-minute walking test （6MWT）, LVEDD, LVEF and the blood levels of TNF-α, IL- 6, MCP-1, hs-CRP were compared before and at 1, 6 and 12 months after CRT between 2 groups. Results： Compared with Control group, CRT group had significantly increased 6MWT , LVEF and decreasedLVEDD at 1, 6, 12 months after treatment, P〈0.05-0.01. In CRT group, the blood levels of TNF-α, IL-6, MCP-1 and hs-CRP were similar at 1 month after CRT, P〉0.05, while they were obviously decrease at 6 and 12 months after CRT, P〈0.01. Compared with Control group, CRT group had significantly decreased TNF-α, IL-6, MCP-1 and hs-CRP, P〈0.05. Conclusion： CRT may correct the hemodynamic disturbance in CHF patients with decreased LVEDD, increased LVEF. The related inflammatory factors could be reduced at 6 months after CRT.