心脏再同步化治疗对慢性心力衰竭患者炎症反应和心室重构的影响

摘要

Objective:To observe influence of cardiac resynchronization therapy (CRT ) on ventricular remodeling and inflammation in patients with chronic heart failure (CHF) .Methods :A total of 84 CHF patients treated in our hospital from Jun 2012 to Feb 2015 were selected , according to randam number table , they were randomly and e‐qually divided into routine treatment group (received routine medication ) and combined treatment group (received CRT based on routine treatment group) .Left ventricular ejection fraction (LVEF) ,left ventricular end -diastolic dimension (LVEDd) ,6min walking distance (6MWD) ,levels of high sensitive C reactive protein (hsCRP) ,inter‐leukin (IL)‐6 and tumor necrosis factor (TNF)–αwere compared between two groups before and three months after treatment .Results:Compared with before treatment ,three months after treatment ,there were significant rise in LVEF and 6MWD ,and significant reductions in LVEDd ,levels of hsCRP ,IL‐6 and TNF‐α in combined treatment group ( P<0.05 or < 0.01 ) ,while there were no significant improvements in above indexes in routine treatment group .Compared with routine treatment group ,there were significant rise in LVEF ± [(29.42 ± 4.32)%vs .(37.16 ± 4.72)% ] and 6MWD [ (232.66 ± 40.54) m vs .(304.12 ± 51.65) m] ,and significant reductions in LVEDd [ (64.35 ± 7.81) mm vs .(57.64 ± 6.12) mm] ,levels of hsCRP [ (23.21 ± 3.45)μg/ml vs .(16.31 ± 2.02)μg/ml] ,IL‐6 [ (22.08 ± 3.82)μg/ml vs .(15.79 ± 2.09)μg/ml] and TNF‐α[ (32.66 ± 5.66)μg/ml vs .(23.23 ± 3.12)μg/ml] in combined treatment group , P<0.05 or <0.01. Conclusion:CRT can significantly reduce levels of hsCRP ,IL‐6 and TNF‐αin CHF patients ,which may be the main mechanism delaying ventricular remodeling and improving cardiac function .%目的：观察心脏再同步化治疗（CRT）对慢性心力衰竭（CHF）患者心室重构和炎症反应的影响。方法：选择我院2012年6月至2015年2月收治的CHF患者84例，根据随机数字表法随机均分为常规治疗组（接受常规药物治疗）和联合治疗组（在常规治疗组基础上加用 CRT ）。比较两组治疗前、治疗后3个月左室射血分数（LVEF）、左室舒张末期内径（LVEDd）、6min步行距离（6MWD）、高敏C反应蛋白（hsCRP）、白介素‐6（IL‐6）和肿瘤坏死因子α（TNF‐α）水平。结果：与治前比较，联合治疗组治疗3个月后 LVEF和6MWD显著升高， LVEDd、hsCRP、IL‐6和TNF‐α水平显著降低（P＜0.05或＜0.01），而常规治疗组上述指标无明显改善；与常规治疗组比较，联合治疗组LVEF [（29.42±4.32）％比（37.16±4.72）％]和6MWD [（232.66±40.54） m比（304.12±51.65） m]显著升高， LVEDd [（64.35±7.81） mm比（57.64±6.12） mm]、hsCRP [（23.21±3.45）μg／ml比（16.31±2.02）μg／ml]、IL‐6[（22.08±3.82）μg／ml比（15.79±2.09）μg／ml]和 TNF‐α[（32.66±5.66）μg／ml比（23.23±3.12）μg／ml]水平显著降低（P＜0.05或＜0.01）。结论：心脏再同步化治疗可以显著降低慢性心力衰竭患者hsCRP、IL‐6、TNF‐α水平，这可能是其延缓心室重塑和改善心功能的主要作用机制。