血清NT- pro- BNP和MMP-9水平变化评价慢性心力衰竭患者心脏再同步化治疗疗效的可行性研究

目的探讨心脏再同步化治疗（CRT）前后心力衰竭患者血清N端脑钠肽（NT- pro- BNP）、基质金属蛋白酶9（MMP-9）水平变化评价CRT疗效的可行性。方法21例慢性心力衰竭患者行CRT（CRT组），另21例慢性心力衰竭患者因经济等原因未接受CRT（对照组），两组基础用药相似。观察并比较两组患者治疗前与治疗后1、3、6个月的NYHA心功能分级、心电图QRS宽度、LVEDD、LVEF、血清NT- pro- BNP及MMP-9的水平（采用ELISA法）。结果 CRT组治疗前血清NT- pro- BNP和MMP-9水平分别为（912.5±194.2）pmol/L、（682.9±282.1）ng/L，CRT 1、3、6个月血清 NT- pro- BNP 水平分别为（379.8±200.5）、（284.7±151.6）、（185.4±82.0）pmol/L，MMP-9水平分别为（543.5±208.3）、（401.1±144.8）、（383.0±198.4）ng/L；而对照组治疗1、3、6个月血清NT- pro- BNP水平分别为（614.1±234.6）、（572.1±165.6）、（553.6±130.1）pmol/L，MMP-9水平分别为（665.6±227.8）、（641.2±268.6）、（573.7±135.9）ng/L。CRT组术后血清NT- pro- BNP和MMP-9水平显著低于术前及对照组（均P＜0.05）。结论慢性心力衰竭患者CRT后血清中NT- pro- BNP和MMP-9水平显著下降，心功能得到改善，血清MMP-9和NT- pro- BNP可以作为评价CRT疗效的生化指标。

Serum levels of N-terminal pro-brain natriuretic peptide and matrix metalloproteinase-9 in patients with chronic heart failure before and after cardiac resynchronization therapy

Objective To investigate serum levels of N- terminal pro- brain natriuretic peptide （NT- pro- BNP） and matrix metal oproteinase - 9 （MMP- 9） in patients with chronic heart failure （CHF） before and after cardiac resynchronization therapy （CRT）. Methods Twenty one CHF patients undergoing cardiac resynchronization therapy（CRT group） and other 21 CHF patients without CRT （control group） were enrol ed in the study;both groups received the same conventional management. Cardiac func-tion （NYHA classification）, QRS wave, left ventricular ejection fraction （LVEF）, left ventricular end- diastolic diameter （LVEDD） were determined, and serum NT- pro- BNP and MMP- 9 levels were measured with ELISA. Results The serum NT- pro- BNP and MMP- 9 levels in CRT group were （912.5±194.2） pmol/L and （682.9±282.1）ng/L before CRT;at 1, 3 and 6 months after CRT the NT- pro- BNP levels were （379.8±200.5）, （284.7±151.6） and （185.4± 82.0） pmol/L respectively, and serum MMP- 9 levels were （543.5±208.3）, （401.1±144.8） and （383.0±198.4）ng/L, respectively. Serum NT- pro- BNP and MMP- 9 levels in control group were （614.1 ±234.6）, （572.1 ±165.6）, （553.6 ±130.1） pmol/L and （665.6 ±227.8）, （641.2 ±268.6） and （573.7 ±135.9）ng/L, re-spectively at the same time points. Serum NT- pro- BNP and MMP- 9 levels in CRT group after CRT were significantly were lower than preoperative levels and than those in control group （P〈0.05）. Conclusion Serum NT- pro- BNP and MMP- 9 levels de-crease significantly with the improvement of cardiac function in CHF patients after CRT indicating that serum NT- pro- BNP and MMP- 9 levles can be used as indicators for evaluating effectiveness of CRT.