CAJ | 학술논문

目的：观察再同步化治疗（CRT）对慢性心衰（CHF）患者心功能改善情况，探讨血清NT-proBNP、TIMP-1、ADM、IL-6、hs-CRP水平检测能否预测CRT的疗效，并对左室射血分数与NT-proBNP的相关性进行研究，分析宽、窄QRS组间CHF患者的相关指标有无差异。方法：将符合标准的入选人群分为：正常对照组（20例）、CHF并窄QRS组（10例）、CHF并宽QRS组（12例），共3组。术前、术后3月检测血清NT-proBNP、TIMP-1、ADM、IL-6、hs-CRP水平以评估宽、窄QRS组对CRT疗效的预测价值。观察心功能改善情况与NT-proBNP的相关性。用Kaplan-Meier法分析宽、窄QRS组间CHF患者相关指标有无差异。结果：①宽、窄QRS组CHF患者血清NT-proBNP、TIMP-1、ADM、IL-6、hs-CRP水平高于正常对照组（P<0.05）。②术前血清NT-proBNP、TIMP-1、ADM、IL-6、hsCRP水平在宽、窄QRS组间差异无统计学意义（P>0.05）。③术前、术后血清NT-proBNP、TIMP-1、ADM、IL-6、hsCRP水平在CHF患者（包括宽QRS组、窄QRS组）中差异有统计学意义（P<0.05）。④术后血清NT-proBNP、TIMP-1、ADM、IL-6、hsCRP水平在宽、窄QRS组间差异无统计学意义（P>0.05）。⑤LVEF与NT-proBNP显著负相关（P<0.001）。⑥宽、窄QRS组相关指标差异无显著性意义（P>0.05）。结论：NT-proBNP、TIMP-1、ADM、IL-6、hs-CRP与左室重构、心功能不全的发生、发展和转归相关，其血清水平随心脏负荷增加而升高，且与心衰、术后心脏事件有关。因此，它们在一定程度上反映CHF严重性及危险程度。使用心脏超声新技术筛选CHF患者，对窄QRS波左室不同步者，亦可通过CRT获益。
목적：관찰재동보화치료（CRT）대만성심쇠（CHF）환자심공능개선정황，탐토혈청NT-proBNP、TIMP-1、ADM、IL-6、hs-CRP수평검측능부예측CRT적료효，병대좌실사혈분수여NT-proBNP적상관성진행연구，분석관、착QRS조간CHF환자적상관지표유무차이。방법：장부합표준적입선인군분위：정상대조조（20례）、CHF병착QRS조（10례）、CHF병관QRS조（12례），공3조。술전、술후3월검측혈청NT-proBNP、TIMP-1、ADM、IL-6、hs-CRP수평이평고관、착QRS조대CRT료효적예측개치。관찰심공능개선정황여NT-proBNP적상관성。용Kaplan-Meier법분석관、착QRS조간CHF환자상관지표유무차이。결과：①관、착QRS조CHF환자혈청NT-proBNP、TIMP-1、ADM、IL-6、hs-CRP수평고우정상대조조（P<0.05）。②술전혈청NT-proBNP、TIMP-1、ADM、IL-6、hsCRP수평재관、착QRS조간차이무통계학의의（P>0.05）。③술전、술후혈청NT-proBNP、TIMP-1、ADM、IL-6、hsCRP수평재CHF환자（포괄관QRS조、착QRS조）중차이유통계학의의（P<0.05）。④술후혈청NT-proBNP、TIMP-1、ADM、IL-6、hsCRP수평재관、착QRS조간차이무통계학의의（P>0.05）。⑤LVEF여NT-proBNP현저부상관（P<0.001）。⑥관、착QRS조상관지표차이무현저성의의（P>0.05）。결론：NT-proBNP、TIMP-1、ADM、IL-6、hs-CRP여좌실중구、심공능불전적발생、발전화전귀상관，기혈청수평수심장부하증가이승고，차여심쇠、술후심장사건유관。인차，타문재일정정도상반영CHF엄중성급위험정도。사용심장초성신기술사선CHF환자，대착QRS파좌실불동보자，역가통과CRT획익。
Objective: To abserve the improvement degree of cardiac function on cardiac resynchronization therapy(CRT) in patients with chronic heart failure (CHF) ,to measure of concentration of NT-proBNP、TIMP-1、ADM, IL-6、hs-CRP in the serum and try to explore wether we can predict the effect of CRT in patients with CHF and investigated the correlation of left ventricular ejection fraction (LVEF) and the serum level of NT-proBNP and analysised the difference of survival index in patiets with a widened QRS complex group or not. Methods:The patiets chosen by adoption standards are divided into 3 groups: control group(20 cases), chronic heart failure with a widened QRS complex(12 cases) and chronic heart failure with a shortening QRS durasion(10 cases).The concentrasion of NT-proBNP, TIMP-1, ADM, IL-6, hs-CRP in serum have been test in Preoperation and postoperative 3 months to predict the effect after CRT. To abserve the correlation of the improvement degree of cardiac function and NT-proBNP in serum level. Wether or not the difference of survival index between the broad QRS group and the narrow QRS group has been analysised by the Kaplan-Meier. Result:① In CHF groups including narrow QRS group and broad QRS group, the mean levels of serum NT-proBNP、TIMP-1、ADM、IL-6、hs-CRP were higher than control group (P<0.05).②However, in preoperation the serum concentrasion of NT-proBNP、TIMP-1、ADM、IL-、 hs-CRP showed no statistical y significant difference in CHF patienis with a widened QRS complex group or not (P>0.05). ③In CHF groups including narrow QRS group and broad QRS group, the serum levels of NT-proBNP、TIMP-1、ADM、IL-6、hs-CRP in Preoperation were greater more than them in postoperation(P<0.05). ④In postoperation, the concentrasion of NT-proBNP, TIMP-1, ADM, IL-6, hs-CRP in the serum showed no statistical y significant difference in CHF patienis with a widened QRS complex group or not (P>0.05).⑤There are significant negative correlations between the LVEF and the level of Serum NT-proBNP ((P<0.001).⑥The difference of survival index between the broad QRS group and the narrow QRS group was not statistical y significant (P>0.05).Conclusion: Serum NT-proBNP, TIMP-1, ADM, IL-6, hs-CRP related with Left ventricular remodeling and initiation 、process and outcome of cardiac dysfunction. Their blood levels increased along with capacity or pressure load in heart chambers and are correlated to the heart failure and heart attack postoperaton. As a result, they reflect the seriousness and the danger of CHF in a certain extent . Echocardiography can be used to screen patients , and left ventricular synchronous in narrow QRS can be also benefited from CRT.