肾功能对心脏再同步治疗的影响

Impact of renal function on cardiac resynchronization therapy

目的 通过观察患者心脏再同步治疗（CRT）前后肾功能的变化情况,旨在探讨肾功能对CRT疗效的影响.方法 选取2001年12月至2012年11月间202例在安徽省立医院植入CRT的患者,分别在术前、术后1个月和6个月检测患者的肾功能,通过估计的肾小球滤过率（eGFR）来评价肾功能水平.术后随访6个月,观察患者肾功能的变化情况以及与CRT疗效的关系.结果 共入选202例CRT患者,有40例（19.8％）患者符合慢性肾功能不良（CKD）标准,与非CKD组相比,CKD组患者的年龄大、缺血性心肌病多.术后有146例（72.3％,有反应组）CRT有效,有反应组患者在术后6个月时肾功能显著改善.根据术前eGFR水平的不同,将CRT患者分为肾功能中重度损害组、轻度损害组和正常组,各组患者的CRT疗效差异有统计学意义（P=0.024）,随着肾功能的下降,CRT疗效逐渐变差.结论 术前eGFR水平与CRT的疗效显著相关,随着肾功能的下降,CRT疗效逐渐变差.同时,CRT亦可改善肾功能,在术后6个月时更为显著.

Objective To explore the impact of renal function on cardiac resynchronization therapy （CRT） by observing the variation of renal function before and after pacemaker implantation. Methods Pa- tients underwent CRT were enrolled in this study from December 2001 to November 2012.Renal function was as- sessed by estimated glomerular filtration rate （ eGFR）, and was detected before, one month and six months after CRT.The variation of renal function and its relationship with effect of CRT were evaluated during six-month fol- low-up. Results Two hundreds and two patients were included in this study,40 （ 19. 8%） of whom had chronic kidney disease（CKD）.Patients with CKD were older and more likely to had ischemic cardiomyopathy than pa- tients without CKD.One hundred and forty-six patients （72. 3% ,response group） responded to CRT.Renal function was significantly improved after six months of CRT.Patients were divided into moderate and severe decreased renal function group ,mildly decreased renal function group and control,according to the level of eGFR.Tbere were signifi- cant difference in the effect of CRT among the three groups （P=0. 024）.With the decrease of renal function,the effect of CRT was decreased. Conclusion The level of baseline eGFR is associated with the effect of CRT.With the decrease of renal function,the effect of CRT declines.Renal function also can be improved after six months of CRT.