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目的:探讨血浆氮末端-前体脑钠肽(NT-proBNP)水平对心脏再同步化治疗(CRT)近期临床疗效的预测价值。方法:入选成功施行CRT的心力衰竭(心衰)患者42例,ELISA法测定血浆NT-proBNP水平。随访6个月,记录心功能分级、左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、QRS间期及心血管事件(心衰再入院、恶性心律失常、心脏性猝死)。结果:入选患者中,CRT有反应者34例,无反应者8例,有效率达81%。CRT术前反应组血浆NT-proBNP水平低于无反应组(P<0.05)。CRT术后6个月反应组LVEF、LVEDd、QRS间期与无反应组比较,均差异有统计学意义(均P<0.01)。Logistic回归分析显示术前NT-proBNP能独立预测CRT临床疗效。术前NT-proBNP对CRT近期临床疗效判定的ROC曲线下面积为0.770,灵敏度为87.5%,特异度为55.9%。结论:血浆NT-proBNP水平可作为评价CRT近期临床疗效的指标。
Objective: To investigate the predictive value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level in the treatment of cardiac resynchronization (CRT) in the near future. Methods: Forty-two patients with heart failure (CHF) who were successfully treated with CRT were enrolled in this study. Plasma NT-proBNP levels were measured by ELISA. The patients were followed up for 6 months. Cardiac function, LVEF, LVEDd, QRS interval and cardiovascular events were recorded. Results: Of the patients selected, 34 had CRT responders and 8 had no response, with an effective rate of 81%. The level of NT-proBNP in CRT preoperative group was lower than that in non-reaction group (P <0.05). There were significant differences in LVEF, LVEDd and QRS interval between the response group and the non-responsive group at 6 months after CRT (all P <0.01). Logistic regression analysis showed that preoperative NT-proBNP can independently predict the clinical efficacy of CRT. The area under the ROC curve of preoperative evaluation of NT-proBNP in CRT was 0.770, with a sensitivity of 87.5% and a specificity of 55.9%. Conclusion: The level of plasma NT-proBNP can be used as an index to evaluate the clinical efficacy of CRT.