慢性心衰心脏再同步化治疗观丁成彦(曲靖市第一人民医院心内科云南曲靖655000)【摘要】目的：观察再同步化治疗(CRT)对慢性心袞(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)o②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)o③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)o④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)o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。【关键词】心脏再同步化治疗机械收缩同步性心力衰竭【中图分类号】R541.6+2【文献标识码】A【文章编号】2095-1752(2014)13-0056-03TheClinicalStudyontheEffectofCardiacResynchronizationTherapyinPatientswithHeartFailureDingcheng-yan(Departmentofcardiology,QujingNo.lHospital,Qujing，Yunnan,655000)[Abstract]Objective:Toabservetheimprovementdegreeofcardiacfunctiononcardiacresynchronizationtherapy(CRT)inpatientswithchronicheartfailure(CHF),tomeasureofconcentrationofNT-proBNP、TIMP-1、ADM,IL-6、hs-CRPintheserumandtrytoexplorewetherwecanpredicttheeffectofCRTinpatientswithCHFandinvestigatedthecorrelationofleftventricularejectionfraction(LVEF)andtheserumlevelofNT-proBNPandanalysisedthedifferenceofsurvivalindexinpatietswithawidenedQRScomplexgroupornot.Methods:Thepatietschosenbyadoptionstandardsaredividedinto3groups:controlgroup(20cases),chronicheartfailurewithawidenedQRScomplex(12cases)andchronicheartfailurewithashorteningQRSdurasion(10cases).TheconcentrasionofNT-proBNP,TIMP-1,ADM,IL-6,hs-CRPinserumhavebeentestinPreoperationandpostoperative3monthstopredicttheeffectafterCRT.ToabservethecorrelationoftheimprovementdegreeofcardiacfunctionandNT-proBNPinserumlevel.WetherornotthedifferenceofsurvivalindexbetweenthebroadQRSgroupandthenarrowQRSgrouphasbeenanalysisedbytheKaplan—Meier.Result:①InCHFgroupsincludingnarrowQRSgroupandbroadQRSgroup,themeanlevelsofserumNT-proBNP、TIMP-1、ADM、IL-6、hs-CRPwerehigherthancontrolgroup(P<0.05)•②However,inpreoperationtheserumconcentrasionofNT-proBNP、TIMP-1、ADM、IL-、hs-CRPshowednostatisticallysignificantdifferenceinCHFpatieniswithawidenedQRScomplexgroupornot(P>0.05).③InCHFgroupsincludingnarrowQRSgroupandbroadQRSgroup,theserumlevelsofNT-proBNP、TIMP-1、ADM、IL-6、hs-CRPinPreoperationweregreatermorethantheminpostoperation(P<0.05).④Inpostoperation,theconcentrasionofNT-proBNP,TIMP-1,ADM,IL-6,hs-CRPintheserumshowednostatisticallysignificantdifferenceinCHFpatieniswithawidenedQRScomplexgroupornot(P>O.O5).⑤TherearesignificantnegativecorrelationsbetweentheLVEF...