心脏再同步治疗对慢性心力衰竭病人右心室功能和炎症因子水平的影响

Effect of Cardiac Resynchronization Therapy on Right Ventricular Function and Inflammatory Factors in Patients with Chronic Heart Failure

目的观察心脏再同步治疗(CRT)对慢性心力衰竭病人右心室功能和炎症因子水平的影响。方法选取2014年6月—2017年6月在我院接受脏再同步治疗的86例中重度慢性心力衰竭病人,随访6个月。以纽约心脏病协会(NYHA)心功能分级下降1级及以上,且左心室收缩末期容积降低15%以上的病人为观察组,剩余病人为对照组。结果心脏功能指标:术后观察组病人左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)、右室心肌功能指数(RIMP)评分均较术前降低(P <0.05),右室面积变化率(RVFAC)、三尖瓣环收缩期位移(TAPSE)、收缩期右心室侧壁三尖瓣环运动速度(Vsr)及E峰则延长或提高(P <0.05)。对照组各项心脏功能指标和术前比较差异无统计学意义(P>0.05)。与术前比较,观察组术后Tei指数降低,对照组术后Tei指数升高(P <0.05)。炎症指标显示,术后6个月,两组炎症因子表达水平均不同程度降低,观察组术后TNF-α、IL-6、hs-CRP与术前比较差异有统计学意义(P <0.05),而对照组术后TNF-α、IL-6、hs-CRP与术前比较差异无统计学意义(P>0.05)。观察组术后TNF-α、IL-6、hs-CRP表达水平低于对照组(P <0.05)。观察组生活质量各项评分均高于对照组(P <0.05)。结论 CRT治疗CHF是基于右心室和左心室共同改善而发挥作用,术前右心室功能,尤其Tei指数是影响病人术后预后和生活质量的重要因素。

Objective To explore the effect of cardiac resynchronization therapy on the right ventricular function and the level of inflam -matory factors in patients with chronic heart failure.Methods：Eighty six patients with moderate or severe chronic heart failure who re -ceived resynchronization therapy in our hospital from June 2014 to June 2017,were followed up for 6 months.The patients whose NYHAgrading decreased by one grade or more,and the left ventricular end systolic volume decreased by over 15% were taken as the ob -servation group,and the remaining patients were the control group.Results：Sixty- two patients were included in the observation groupand 24 patients in the control group.Except for the Tei index, there were no significant differences in the general data and LVEDV,LVESV,LVEF,RVFAC,TAPSE,RIMP,Vsr,E peak,NYHA score,and inflammation related indexes between the two groups （P 〉0.05）.LVEDV,LVESV,LVEF,and RIMP score were significantly decreased in the observation group （P 〈0.05）,RVFAC,TAPSE,Vsr,and E peak weresignificantly increased （P 〈0.05）.Compared with preoperation, there were no significant improvements in the indexes of the controlgroup （P 〉0.05）.Compared with preoperation, the Tei index in the observation group decreased significantly,while the control groupincreased significantly （P 〈0.05）.The expression levels of inflammatory factors （TNF- alpha,IL -6 and hs- CRP） in the two groupswere reduced to varying degrees,the improvement degree of the observation group was statistically significant （P 〈0.05）,while that inthe control group had no statistically significant change （ P 〉0.05）.The expression levels of inflammatory factors in the observationgroup were significantly lower than that in the control group （ P 〈0.05）.The overall quality of life of the patients in the observationgroup was significantly higher than that in the control group （P 〈0.05）.Conclusion CRT treatment of CHF disease is based on thecommon outcome of right ventricle and left ventricle.Preoperative right ventricular function,especially Tei,is an important factor that in -fluences postoperative prognosis and quality of life.