心力衰竭伴肾功能不全患者CRT植入术后随访研究

The effects of cardiac resynchronization therapy in heart failure patients with renal insufficiency

目的 观察心力衰竭伴肾功能不全患者心脏再同步化治疗（CRT）1年后心功能改善情况.方法 连续入选在我科住院的终末期心力衰竭伴肾功能不全患者36例,评估、测量患者术前、术后1年NYHA分级、左室舒张末期内径（LVEDD）、左室射血分数（LVEF）、血浆B型脑钠肽（BNP）和血浆肌酐浓度.结果 与术前相比,术后1年患者NYHA分级改善（2.5±0.4比3.6±0.3,P＜0.05）,LVEDD缩小[（60.5±6.3）mm比（72.4±6.7）mm,P＜0.05],LVEF增大[（45.2±4.5）％比（27.1±6.6）％,P＜0.05],血浆BNP浓度明显下降[（6094.0±2103.9）pg/ml比（12135.1±3897.1）pg/ml,P＜0.05],血肌酐水平较前明显下降[（1.77±0.23） μg/ml比（2.49±0.36） μg/ml,P＜0.05].结论 心脏再同步化治疗能改善心力衰竭伴肾功能不全患者的心脏功能.

Objective To evaluate the effects of cardiac resynchronization therapy in heart failure patients with renal insufficiency. Methods CRT was implanted in thirty-six heart failure patients with renal insufficiency, NYHA grade, left ventricular diastolic diameter （LVEDD）, left ventricular ejection fraction （LVEF） and B-type natriuretic peptides （BNP）, serum creatinine（Cr） were evaluated before cardiac resynchronization therapy and one year later after cardiac resynchronization therapy. Results Compared to the results before cardiac resynchroniza- tion,one year later, NYHA grade was improved （3.6± 0.3 vs 2.5± 0.4,P〈0.05）, LVEDD was smaller [（72.4± 6.7） mm vs （60.5± 6.3）mm, P〈O.05], LVEF increased [（27.1± 6.6）% vs （45.2± 4.5）%, P〈0.05], BNP decreased [（12135.1± 3897.1）pg/ml vs （6094.0＋2103.9）pg/ml, P〈0.05], Cr also decreased significantly [（2.49± 0.36 ）μg/ml vs （1.77±0.23）μg/ml, P〈0.05 ]. Conclusion Cardiac resynchronization therapy could improve left ventricular function of the heart failure patients with renal insufficiency.