无症状性动静脉瘘肾移植受者闭瘘后左心形态和功能的变化  

Effects of asymptomatic arteriovenous fistula closure on left ventricular morphology and function in renaltransplant recipients-a prospective, randomized, controlled study

作　　者：狄文佳[1,3] 杨洪吉[2] 卢一平[1] 冉清[2] 张宇[2] 邓小凡[2] 熊伟[2] 

机构地区：[1]四川大学华西医院肾移植中心,成都610041 [2]四川省人民医院移植科 [3]四川省人民医院

出　　处：《中华器官移植杂志》2012年第10期594-597,共4页Chinese Journal of Organ Transplantation

基　　金：四川省卫生厅医学科研基金

摘　　要：目的观察无症状性动静脉瘘肾移植受者闭瘘后左心形态和功能的变化。方法连续选取2（）07年3月至2011年3月间符合病例纳入标准的无症状性动静脉瘘肾移植受者60例，采用随机表法将受者分为闭瘘组及对照组，每组各30例。超声心动图检查两组受者，比较组内和组问受者的心输出量（CO）、心脏指数（CI）、射血分数（EF）、左心室舒张末期容积（LVEDV）、左心室质量指数（LVMI）的变化及差异。结果肾移植术后12个月，闭瘘组及对照组受者CO、LVEDV和LVMI较移植前均降低（P〈0．05，P〈0．01，P〈0．05），CI也呈降低趋势（P〉0．05），而EF较移植前升高（P〈0．01）。与术后12个月（闭瘘前）相比较，闭瘘组受者术后18个月（闭瘘后6个月）的CO、CI、LVEDV和LVMI进一步降低（P〈0．01，P〈0．05，P〈0．05，P〈0．05），而EF进一步升高（P〈0．05）。对照组术后18个月的CO、CI、LVEDV、LVMI和EF与移植后12个月时相比较，差异均无统计学意义（P〉0．05）。闭瘘组术后18个月的CO为（4．4±0．8）L／rain，CI为（3．0±0．8）L·min^-1·m^-2，LVEDV为（110．0±17．4）ml，LVMI为（114．7±42．5）g／rn2，均明显低于同期对照组的检测结果（P〈0．01，P〈0．05，P〈0．05，P〈0．05）；闭瘘组术后18个月的EF为（75．2±7．4）％，明显高于同期对照组的结果（P〈20．05）。结论透析患者的左心功能均在肾移植后得到改善，左心肥大有所恢复，闭瘘后左心功能改善及左心肥大的恢复更为明显。Objective To evaluate the effects of asymptomatic arteriovenous fistula closure on left ventricular morphology and function in renal transplant recipients. Methods Between March 2007 and March 2011, a total of 60 patients undergoing consecutive kidney transplantation with asymptomatic arteriovenous fistula were divided randomly into two groups： arteriovenous fistula closure group, and non-arteriovenous fistula closure group. By using echocardiography, the changes in CO, CI, EF, LVEDV and LVMI were analyzed. Results At 12th month after transplantation, the values of CO, LVEDV and LVMI were significantly lower than those before transplantation （P〈 0. 05）. The value of CI also showed a tendency to decrease （P〈0. 05）, and the value of EF was increased significantly （P〈0. 05）. At 6th month after arteriovenous fistula closure （18 months after transplantation）, the values of CO, CI, LVEDV and LVMI were significantly lower than those before arteriovenous fistula closure （12 months after transplantation） （P〈0. 05）, and the value of EF was increased significantly （P〈0. 05）, but the values of CO, CI, EF, LVEDV and LVMI remained unchanged in controls （P〉0. 05）. At 18th month after transplantation, the values of CO （4. 4 ± 0.8 L/min）, CI [3.0±0.8 L-min^-1 ,m^-2, LVEDV （110.0 ±17.4 ml） and LVMI （114.7±42.5 g/m2） in trial group were significantly lower than the values [CO： 5.1 ± 0. 9 L/rain, CI： 3. 5 ± 1.0 L. min^- 1 . m^- 2, LVEDV： 121.4 ＋ 19. 3 mL, LVMI： 138. 4 ± 44. l g/m^2] in controls （P〈0. 05）, and the value of EF （75.2 % ± 7. 4% vs. 70. 5 % ± 8. 2 % ） significantly higher （P〈005）. Conclusion In both groups, kidney transplantation benefits significantly the regression of cardiac mass, cardiac index

关 键 词：动静脉瘘 肾移植 肥大 左心室 心脏功能 超声心动描记术 

分 类 号：R699[医药卫生—泌尿科学]