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右室不同部位起搏对血浆IL-6、ANP水平和左心功能的影响
引用本文:李文华,李 勇,季建国,徐 波,蔡高军,周惠芬,黄艳红,何国平,邹建刚.右室不同部位起搏对血浆IL-6、ANP水平和左心功能的影响[J].南京医科大学学报,2012(9):1254-1258.
作者姓名:李文华  李 勇  季建国  徐 波  蔡高军  周惠芬  黄艳红  何国平  邹建刚
作者单位:南京医科大学第一附属医院心内科,江苏 南京 210029;江苏大学附属武进人民医院心内科,江苏 常州 213002;江苏大学附属武进人民医院心内科,江苏 常州 213002;江苏大学附属武进人民医院心内科,江苏 常州 213002;江苏大学附属武进人民医院心内科,江苏 常州 213002;江苏大学附属武进人民医院心内科,江苏 常州 213002;江苏大学附属武进人民医院心内科,江苏 常州 213002;江苏大学附属武进人民医院心内科,江苏 常州 213002;江苏大学附属武进人民医院心内科,江苏 常州 213002;南京医科大学第一附属医院心内科,江苏 南京 210029
基金项目:国家自然科学基金(81170162)
摘    要:目的:通过比较右心室心尖部(RVA)和右心室中位间隔部(mid-RVS)两种不同部位起搏早期对患者血浆白细胞介素-6(IL-6)?血浆心房利钠肽(ANP)水平和左心功能的影响,探讨IL-6?ANP水平与无症状左心收缩功能(ALVD)不全的相关性?方法:将42例植入DDD型起搏器患者随机分为RVA起搏组?mid-RVS起搏组,观察两组患者起搏器植入术前及术后3个月和6个月血浆IL-6?ANP水平?左房内径(LAD)?左室舒张末期内径(LVEDD)?左室射血分数(LVEF)以及心电图QRS波时限的变化?结果:术前和术后3个月比较,两组患者血浆IL-6?ANP水平和LAD?LVEDD?LVEF等均无明显差异;术后6个月RVA起搏组血浆IL-6?ANP水平和LAD?LVEDD较mid-RVS起搏组显著升高 (P < 0.01);RVA起搏组术后6个月与术前?术后3个月比较,IL-6?ANP水平和LAD?LVEDD等明显升高(P < 0.05),LVEF有降低趋势?术后mid-RVS起搏组QRS波时限明显小于RVA起搏组(P < 0.001)?结论:右室中间隔起搏有助于避免常规右室心尖部起搏导致的血浆IL-6和ANP水平增高以及左房?左室的扩大,可能减少心力衰竭的发生?

关 键 词:右室心尖部    右室中位室间隔    白细胞介素-6    心房利钠肽
收稿时间:2012/4/22 0:00:00

The influence of cardiac pacemaker implantation site on plasma interleukin-6,atrial natriuretic peptide and left ventricular function
LI Wen-hu,LI Yong,JI Jian-guo,XU Bo,CAI Gao-jun,ZHOU Hui-fen,HUANG Yan-hong,HE Guo-ping and ZOU Jian-gang.The influence of cardiac pacemaker implantation site on plasma interleukin-6,atrial natriuretic peptide and left ventricular function[J].Acta Universitatis Medicinalis Nanjing,2012(9):1254-1258.
Authors:LI Wen-hu  LI Yong  JI Jian-guo  XU Bo  CAI Gao-jun  ZHOU Hui-fen  HUANG Yan-hong  HE Guo-ping and ZOU Jian-gang
Institution:Department of Cardiology,the First Affiliated Hospital of NJMU,Nanjing 210029;Department of Cardiology,Affiliated Wujin Hospital of Jiangsu Uninversity,Changzhou 213002,China;Department of Cardiology,Affiliated Wujin Hospital of Jiangsu Uninversity,Changzhou 213002,China;Department of Cardiology,Affiliated Wujin Hospital of Jiangsu Uninversity,Changzhou 213002,China;Department of Cardiology,Affiliated Wujin Hospital of Jiangsu Uninversity,Changzhou 213002,China;Department of Cardiology,Affiliated Wujin Hospital of Jiangsu Uninversity,Changzhou 213002,China;Department of Cardiology,Affiliated Wujin Hospital of Jiangsu Uninversity,Changzhou 213002,China;Department of Cardiology,Affiliated Wujin Hospital of Jiangsu Uninversity,Changzhou 213002,China;Department of Cardiology,Affiliated Wujin Hospital of Jiangsu Uninversity,Changzhou 213002,China;Department of Cardiology,the First Affiliated Hospital of NJMU,Nanjing 210029
Abstract:Objective:To investigate the influence of different cardiac pacemaker implantation site on plasma interleukin-6(IL-6),atrial natriuretic peptide(ANP) and left ventricular systolic function. Methods:Forty-two patients with DDD pacing were randomly divided into two groups:right ventricular apex pacing group (RVA,n = 20) and middle right ventricular septum pacing group (mid-RVS,n = 22). The plasma IL-6,ANP level,LAD,LVEDD,LVEF and QRS complex duration of pre-operation and post-operation were tested. Results:There was no statistical significance of IL-6,ANP level and LAD,LVEDD,LVEF between two groups before implantation and three months after implantation. The plasma leves of IL-6,ANP and LAD,LVEDD in RVA pacing group were higher than those in mid-RVS pacing group six months after implantation(P < 0.01). The plasma leves of IL-6,ANP and LAD,LVEDD in RVA pacing group six months after implantation were higher than those pre-implantation and three months after implantation(P < 0.01). The pacing QRS complexs duration was shorter in mid-RVS pacing group than that in RVA pacing group. Conclusion:Compared with the RVA pacing,mid-RVS pacing can avoid the elevation of IL-6,ANP level,left artial and ventricular dilation and the impairment of left ventricular systolic function.
Keywords:right ventricular apex  middle right ventricular septum  interleukin-6  atrial natriuretic peptide
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