LOT-CRT与BIV-CRT对HFrEF患者的疗效及中医证型分布变化的临床研究

Clinical research on curative effect of LOT-CRT and BIV-CRT in HFrEF patients and changes of TCM syndrome type distribution

目的分析射血分数降低的心衰(heart failure with reduced ejectionfraction,HFrEF)患者左束支区域起搏优化的心脏再同步化治疗(left bundle branch pacing optimized-cardiac resynchronization therapy,LOT-CRT)与双心室起搏的心脏再同步化治疗(biventricular pacing-cardiac resynchronization therapy,BIV-CRT)前后的疗效及中医证型分布的变化特点,为CRT手术策略的选择和中医药的辅助治疗提供依据。方法将2020年1月至2021年11月再北京大学人民医院65例住院确诊HFrEF患者按CRT治疗方案,分为LOT-CRT组(28例)和BIV-CRT组(37例),LOT-CRT组采用左束支区域起搏(LBBP)优化的CRT治疗,BIV-CRT组采用传统的双室起搏CRT治疗,比较两组术前及术后3个月的NYHA心功能分级、QRS时限(QRSd)、左房内径(LA)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF);在术前及术后3个月对患者进行中医证候分型,分为心肺气虚、气阴两虚、气虚血瘀、痰饮阻肺、阳虚水泛5个证型,比较手术前后两组中医证型分布的变化。结果①两组的性别、年龄、病程、病因、用药史等基线资料差异无统计学意义(P>0.05)。②术前两组NYHA心功能分级无差异(P>0.05),两组术后与术前心功能分级均有显著性差异(P<0.001),两组术后心功能分级有显著性差异(P<0.001),LOT-CRT组优于BIV-CRT组。③两组术前QRSd、LA、LVEDD、LVEF均无差异(P>0.05),两组术后QRSd均缩短,LA、LVEDD均缩小,LVEF均升高(P<0.001),两组术后各项指标均显著改善;两组术后QRSd、LVEDD、LVEF有显著性差异(P<0.001),LOT-CRT组优于BIV-CRT组。④两组术前中医证型分布无差异(P>0.05),术后两组中医证型分布有统计学差异(P<0.01),术后两组均以症状较轻的心肺气虚和气阴两虚型为主,症状较重的痰饮阻肺和阳虚水泛型均显著减少,LOT-CRT术后心肺气虚型较BIV-CRT更多。结论LOT-CRT与BIV-CRT对HFrEF均有显著疗效,LOT-CRT疗效优于BIV-CRT;LOT-CRT与BIV-CRT对HFrEF的中医证型分布均有显著改善,LOT-CRT的改善程度比BIV-CRT更明显。

Objective To analyze the curative effect of LOT-CRT and BIV-CRT in HFrEF patients and the characteris⁃tics of TCM syndrome distribution before and after the treatment,so as to provide a basis for the selection of CRT surgical strategy and TCM adjuvant therapy.Methods Totally 65 hospitalized HFrEF patients were divided into LOT-CRT group(37 cases)and BIV-CRT group(28 cases)according to the CRT treatment plan.The LOT-CRT group was treated with optimized left bundle branch area pacing(LBBP),and the BIV-CRT group was treated with traditional biventricular pacing CRT.NYHA cardiac function grading,QRS duration(QRSd),left atrial diameter(LA),left ventricular end-di⁃astolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were compared between the two groups before and 3 months after surgery.Before and 3 months after operation,the patients were divided into five types of TCM syndromes:cardiopulmonary Qi deficiency,Qi and Yin deficiency,Qi deficiency and blood stasis,phlegm blocking lung,edema due to Yang insufficiency.The changes of TCM syndromes distribu⁃tion in the two groups before and after operation were compared.Results①There were no differences in gender,age,course of disease,etiology and medication history between the two groups(P>0.05).②There was no difference in NY⁃HA cardiac function grading between the two groups before surgery(P>0.05),and there was significant difference in postoperative and preoperative cardiac function grading between the two groups(P<0.001).The LOT-CRT group was superior to the BIV-CRT group.③There were no differences in preoperative QRSd,LA,LVEDD and LVEF between the two groups(P>0.05).Postoperative QRSd was shortened,LA and LVEDD were reduced,and LVEF was increased in both groups(P<0.001).All postoperative indicators were significantly improved in both groups.There were significant differences in postoperative QRSd,LVEDD and LVEF between the two groups(P<0.001),and LOT-CRT group was superior to BIV-CRT group.④There was no difference in the distribution of TCM syndrome types between the two groups before surgery(P>0.05),but there was statistical difference in the distribution of TCM syndrome types between the two groups after surgery(P<0.01).After surgery,the two groups were mainly characterized by the mild symptom types of cardiopulmonary Qi deficiency and Qi Yin deficiency,while the severe symptom types of phlegm blocking lung and edema due to Yang insufficiency were significantly reduced.After LOT-CRT,there were more cardiopulmonary Qi deficiency than BIV-CRT.Conclusion Both LOT-CRT and BIV-CRT have significant curative effect on HFrEF,and LOT-CRT is superior to BIV-CRT;LOT-CRT and BIV-CRT significantly improved the distribution of TCM syndrome types of HFrEF,and the improvement degree of LOT-CRT was more obvious than that of BIV-CRT.