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目的本文通过观察心肌病患者CRT手术前后Ⅰ型前胶原氨端肽(P-ⅠNP)、Ⅲ型前胶原羧基端肽(P-ⅢCP)和Ⅳ型胶原(Ⅳ-C)的血清浓度的变化以及与心衰的关系,初步探讨其与CRT对心肌纤维化的影响。方法选择2009年1月～2009年8月行CRT的患者(CRT组),另选择与上述患者同期住院年龄相近的患者作为对照组。记录患者病程、心脏超声指标等基线情况。共入选符合标准的患者40例,其中CRT组和对照组各20例。随访6个月,主要终点为因心力衰竭而住院,6个月内无心衰住院者作为CRT1组,出现心衰住院者作为CRT2组。采用放免法检测所有患者术前、术后1月、3月和6月血清标本中P-ⅠNP,P-ⅢCP以及Ⅳ-C的浓度。结果 P-ⅠNP、P-ⅢCP以及Ⅳ-C血清浓度与左室舒张末期内径、病程长短成正相关,与左室射血分数呈负相关。CRT组患者术后P-ⅠNP、P-ⅢCP以及Ⅳ-C血清浓度呈逐渐下降的趋势,一直持续至术后6月,差异有统计学意义(p<0.05);对照组在随访期间无显著变化。为期半年的随访表明,出现心衰再住院的CRT患者P-ⅠNP、P-ⅢCP以及Ⅳ-C血清浓度显著高于未出现心衰者。结论心肌病患者P-ⅠNP、P-ⅢCP以及Ⅳ-C血清浓度与心衰的严重程度相关,CRT可显著降低其水平,并可反映CRT疗效。
Objective To observe the change of serum concentration of type Ⅰ procollagen P-ⅠNP, type Ⅲ procollagen carboxyterminal peptide (P-ⅢCP) and type Ⅳ collagen (Ⅳ-C) before and after CRT in patients with cardiomyopathy And the relationship between heart failure and its impact on myocardial fibrosis with CRT. Methods The patients who underwent CRT (CRT group) from January 2009 to August 2009 were selected as the control group. Record the patient’s course of disease, cardiac ultrasound and other baseline conditions. A total of 40 eligible patients were enrolled, including 20 patients in CRT group and control group. The patients were followed up for 6 months. The main end point was hospitalization due to heart failure. Those who had no heart failure within 6 months were treated as CRT1 group and those with heart failure as CRT2 group. The radioimmunoassay was used to detect the concentrations of P-ⅠNP, P-ⅢCP and Ⅳ-C in all the patients before, one month, three months and six months after operation. Results Serum concentrations of P-ⅠNP, P-ⅢCP and Ⅳ-C were positively correlated with the diameter and duration of left ventricular end-diastolic volume and negatively correlated with left ventricular ejection fraction. The serum levels of P-ⅠNP, P-ⅢCP and Ⅳ-C in CRT group showed a trend of decreasing gradually until lasted 6 months, the difference was statistically significant (p <0.05); there was no significant difference in the control group during follow-up Variety. A six-month follow-up showed that serum concentrations of P-I NP, P-III CP and IV-C were significantly higher in patients with CRT who were hospitalized for heart failure than in those without heart failure. Conclusions The serum concentrations of P-ⅠNP, P-ⅢCP and Ⅳ-C in patients with cardiomyopathy are related to the severity of heart failure. CRT can significantly reduce the level of CRT and reflect the curative effect of CRT.