| 殷艳蓉,李 敏,成 思,田 刚,梁 潇.心脏再同步治疗对非缺血性心肌病患者心肌胶原代谢的影响[J].,2021,(20):3882-3887 |
| 心脏再同步治疗对非缺血性心肌病患者心肌胶原代谢的影响 |
| Effects of Cardiac Resynchronization Therapy on Myocardial Collagen Metabolism in Non-ischemic Cardiomyopathy |
| 投稿时间：2021-03-28 修订日期：2021-04-23 |
| DOI：10.13241/j.cnki.pmb.2021.20.016 |
| 中文关键词: 心脏再同步治疗 非缺血性心肌病 胶原代谢 |
| 英文关键词: Cardiac resynchronization therapy Non-ischemic cardiomyopathy Collagen metabolism |
| 基金项目:陕西省重点研发计划国际科技合作项目（2020KW-051）；西安交通大学第一附属医院院基金项目（2019ZYTS-08） |
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| 中文摘要: |
| 摘要 目的：探讨心脏再同步治疗（CRT）对非缺血性心肌病（NICM）患者心肌胶原代谢的影响。方法：选取NICM患者76例，其中仅接受标准药物治疗者26例（Control组），接受CRT及标准药物治疗者50例（CRT组）。分别于基线、6月及12月检测外周血中心肌胶原代谢的标记物I型胶原羧基末端前肽（PICP）、I型胶原羧基端肽（ICTP）、基质金属蛋白酶-1（MMP-1）及组织金属基质蛋白酶抑制剂-1（TIMP-1）的变化。随访12月时左室射血分数（LVEF）值与基线比较净值增长5 %定义为患者临床治疗有反应。结果：与基线比较，CRT组患者术后6月、12月PICP、ICTP及MMP-1均明显降低（P均<0.05）；Control组患者术后6月、12月PICP、ICTP、MMP-1及TIMP-1与基线比较均未显示统计学差异。40例(53 %)患者临床治疗有反应，其中CRT组33例（67 %）明显高于Control组7例（27 %），两组间具有统计学差异（P=0.01）。多因素logistics回归分析显示QRS间期，LVEF，PICP为临床反应预测因子。结论：CRT可以降低NICM患者的心肌胶原合成和分解，减缓心肌纤维化；检测患者基线PICP可预测患者治疗的临床反应，为NICM的临床诊治提供一定的参考价值。 |
| 英文摘要: |
| ABSTRACT Objective: To assess the effects of cardiac resynchronization therapy (CRT) on myocardial collagen metabolism among patients with non-ischemic cardiomyopathy (NICM). Methods: Seventy-six patients with NICM were enrolled in this study: 26 patients receiving standard medical therapy along (Control group), 50 patients undergoing CRT implantation and standard medical therapy (CRT group). Collagen metabolism were assessed from the carboxy-terminal propeptide of procollagen type I(PICP), carboxy-terminal telopeptide of type I collagen (ICTP), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of matrix metalloproteinase-1(TIMP-1) in serum, respectively, at baseline, 6 months and 12 months follow-up. Patients were considered responders to therapy if they exhibited ≥5 % absolute increase in left ventricular ejection fraction(LVEF) at 12 months follow-up. Results: Compared with baseline, PICP, ICTP and MMP-1 were significantly lower in the CRT group at 6 months and 12 months(all P<0.05), whereas this effect was not evident among patients who were enrolled in control group. Forty patients (53 %) were classified as responders to therapy: 33 patients (67 %) in CRT group compared with 7 patients (27 %) in control group(P=0.01). On multivariate stepwise logistic regression analysis, QRS duration, LVEF and PICP were significant predictors of response to therapy. Conclusion: CRT reduces the synthesis and degradation of collagen in patients with NICM, and slows down myocardial fibrosis; the concentration of PICP in serum can predict the clinical response to treatment, which is valuable for the clinical diagnosis and treatment of NICM. |
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