终末期心力衰竭合并肺动脉高压患者心脏移植的预后  

Prognosis of End-stage Heart Failure Patients With Pulmonary Hypertension Post Heart Transplantation

作　　者：郑珊珊[1] 刘盛[1] 宋云虎[1] 黄洁[2] 廖中凯[2] 侯剑峰[1] 唐汉韡 郑哲[1] ZHENG Shanshan;LIU Sheng;SONG Yunhu;HUANG Jie;LIAO Zhongkai;HOU Jianfeng;TANG Hanwei;ZHENG Zhe(Department of Cardiac Surgery,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科心力衰竭与移植病房,北京市100037

出　　处：《中国循环杂志》2022年第3期226-233,共8页Chinese Circulation Journal

摘　　要：目的:探索终末期心力衰竭合并肺动脉高压患者心脏移植后围术期及远期预后。方法:回顾959例心脏移植受者的临床资料,根据术前肺动脉收缩压(PASP)水平分为PASP<40 mmHg组(n=441,1 mmHg=0.133 kPa)、40 mmHg≤PASP<50 mmHg组(n=211)和PASP≥50 mmHg组(n=307),并对术前PASP<40mmHg及PASP≥40 mmHg患者分别分为肺血管阻力(PVR)<3 wood单位(WU)、3 WU≤PVR<5 WU及PVR≥5WU亚组。比较各组受者的围术期情况和远期预后,探索各肺动脉循环指标与围术期死亡风险的关系。结果:PASP<40 mmHg组、40 mmHg≤PASP<50 mmHg组和PASP≥50 mmHg组受者男性比例、吸烟史比例、术前总胆红素水平、N末端B型利钠肽原(NT-proBNP)水平、术前主动脉内球囊反搏支持比例、供受者体重匹配率、性别匹配率差异均有统计学意义(P均<0.05)。不同PASP组术后远期生存率差异无统计学意义(P=0.13)。在PASP≥40 mmHg受者中,PVR≥5 WU亚组受者术后30 d生存率显著低于PVR<3 WU及3 WU≤PVR<5 WU亚组(P=0.02),而术后5年的生存率差异无统计学意义(P>0.05)。校正相关因素后未发现术前各肺循环指标与围术期死亡率风险存在显著相关性(P均>0.05)。结论:心脏移植前PASP及PVR均升高的受者心脏移植后早期预后较差,远期预后差异无统计学意义。Objectives: To explore the impact of pulmonary hypertension(PH) on the perioperative and long-term prognosis after heart transplantation(HTx) in patients with end-stage heart failure.Methods: Clinical data of 959 HTx recipients were retrospectively reviewed and patients were divided into three groups according to preoperative pulmonary artery systolic pressure(PASP): PASP<40 mmHg(n=441, 1 mmHg=0.133 kPa),40 mmHg≤PASP<50 mmHg(n=211), and PASP≥50 mmHg(n=307). Subgroup analysis was conducted in PASP<40 mmHg and PASP≥40 mmHg group respectively by dividing them into three respective subgroups according to pulmonary vascular resistance(PVR): PVR <3 wood unit(WU), 3 WU≤PVR<5 WU, and PVR≥5 WU. Perioperative outcomes and long-term prognosis were compared between different groups. The relationship between pulmonary artery circulation indicators and perioperative mortality risk was analyzed.Results: There were significant differences on the proportion of male and smoking history, the level of total bilirubin and NT-proBNP, and the donor/recipient weight matching rate and gender matching rate, the ratio of preoperative intra-aortic balloon pump among PASP<40 mmHg, 40 mmHg≤PASP<50 mmHg and PASP≥50 mmHg groups(all P<0.05). The long-term survival rate after HTx was similar among the three groups(P=0.13). In patients with PASP≥40 mmHg, the 30-day survival rate of patients in the PVR ≥5 WU group was significantly lower than that of the patients in the PVR<3 and 3 WU≤PVR<5 WU groups(P=0.02). There was no significant difference in the 5-year survival rate after HTx among the three subgroups(P>0.05).After adjusting for related factors, there was no significant correlation between the preoperative pulmonary circulation indexes and the risk of perioperative mortality(P>0.05).Conclusions: Patients with elevated PASP and PVR before HTx is related to poor early postoperative prognosis, but the long-term prognosis is not affected by pre-HTx PASP and PVR.

关 键 词：心脏移植 肺动脉高压 生存分析 围术期管理 

分 类 号：R54[医药卫生—心血管疾病]