摘要
目的观察不同基础肾功能心力衰竭患者实施心脏再同步化治疗(CRT)术后预后的差异。方法前瞻性选择2014年1月至2016年1月广东医科大学附属第三医院心内科收治的60例心力衰竭患者为研究对象,所有患者拟行CRT治疗,根据术前肾小球滤过率(GFR)将患者分为A组[GFR≥90 mL/(min·1.73 m^2),20例]、B组[60 mL/(min·1.73 m^2)≤GFR≤89 mL/(min·1.73 m^2),20例]和C组[GFR<60 mL/(min·1.73 m^2),20例]。观察三组患者术前(T0)、术后1个月(T2)、6个月(T3)的GFR、血清利钠肽(BNP)、左室射血分数(LVEF)、左室收缩末容积(LVESV)、纽约心脏协会(NYHA)心功能分级的变化,并观察患者预后的差异。结果三组患者术后1个月BNP、LVESV、NYHA心功能分级显著下降,LVEF显著上升,差异均有统计学意义(P<0.05);术后6个月,A组和B组患者的BNP、LVESV、NYHA心功能分级继续下降,LVEF继续上升,差异均有统计学意义(P<0.05),但C组BNP、LVESV、NYHA心功能分级、LVEF比较,差异均无统计学意义(P>0.05);C组患者的全因死亡率为25.0%,明显高于B组的5.0%和A组的0,差异均有统计学意义(P<0.05);C组中位生存期(2.68±0.24)年,明显少于B组和A组[(3.32±0.51)年、(3.56±0.57)年],差异均有统计学意义(P<0.05);A组、B组和C组患者的三年生存率分别为96.52%、93.02%、71.03%,差异有统计学意义(P<0.05)。结论 CRT术前基础肾功能对心力衰竭患者近远期疗效影响较大,完善术前肾功能评估可指导CRT治疗。
Objective To observe the difference of prognosis after cardiac resynchronization therapy(CRT) in patients with different basic renal failure and heart failure. Methods From January 2014 to January 2016, 60 patients with heart failure admitted to the Third Affiliated Hospital of Guangdong Medical University were prospectively selected. All patients underwent CRT treatment. According to preoperative glomerular filtration rate(GFR), the patients were divided into group A(GFR>90 m L/[min·1.73 m^2], 20 cases), group B(60 m L/[min·1.73 m^2]<GFR<89 m L/[min·1.73 m^2],20 cases), and group C(GFR<60 m L/[min·1.73 m^2], 20 cases). The changes of GFR, serum natriuretic peptide(BNP),left ventricular ejection fraction(LVEF), left ventricular end systolic volume(LVESV), and New York Heart Association(NYHA) cardiac function grading before operation(T0), 1 month(T2), 6 months(T3) after operation were observed,and the prognosis of the patients was compared. Results One month after operation, BNP, LVESV, NYHA cardiac function grading decreased significantly(P<0.05), and LVEF increased significantly(P<0.05). Six months after operation, BNP, LVESV, NYHA cardiac function grading continued to decline(P<0.05) and LVEF continued to rise(P<0.05)in group A and group B, but BNP, LVESV, NYHA cardiac function grading and LVEF did not change significantly in group C(P>0.05). The all-cause mortality of group C was 25.0%, significantly higher than 5.0% of group B and 0 of group A(P<0.05), and the median survival time of group C was 2.68±0.24, significantly lower than 3.32±0.51 of group B and 3.56 ± 0.57 of group A(P<0.05). The three-year survival rates of the three groups were 96.52%, 93.02%, and71.03%, respectively, with significant differences among the three groups(P<0.05). Conclusion The basic renal function before CRT has a great influence on the short-term and long-term efficacy of heart failure patients. Preoperative renal function evaluation can guide the CRT treatment.
作者
罗承志
朱士彦
江文科
陈剑泉
LUO Cheng-zhi;ZHU Shi-yan;JIANG Wen-ke;CHEN Jian-quan(Department of Nephrology Departmentof Cardiology the Third Affiliated Hospital of Guangdong Medical University, Foshan 528318, Guangdong, CHINA;Department of Nephrology the Third Affiliated Hospital of Guangdong Medical University, Foshan 528318, Guangdong, CHINA)
出处
《海南医学》
CAS
2019年第10期1242-1245,共4页
Hainan Medical Journal
基金
广东省佛山市卫生和计生局医学科研课题立项(编号:20190338)
关键词
心力衰竭
肾功能
再同步化治疗
预后
肾小球滤过率
Heart failure
Renal function
Resynchronization therapy
Prognosis
Glomerular filtration rate(GRF)
