肺移植治疗终末期肺动脉高压的预后分析  

Prognosis of lung transplantation in the treatment of end-stage pulmonary arterial hypertension

作　　者：王红梅[1] 吴波[1] 范立[1] 周敏[1] 杨航[1] 卫栋[1] 张才新 熊点 岳冰清 周海琴[1] 陈静瑜[1] WANG Hongmei;WU Bo;FAN Li;ZHOU Min;YANG Hang;WEI Dong;ZHANG Caixin;XIONG Dian;YUE Bingqing;ZHOU Haiqin;CHEN Jingyu(Department of Pulmonary and Critical Care Medicine,Lung Transplantation Center,Wuxi People’s Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡市人民医院呼吸与危重症医学科肺移植中心,江苏无锡214023

出　　处：《中国呼吸与危重监护杂志》2022年第8期572-576,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨肺移植治疗终末期肺动脉高压患者的预后情况及生活质量。方法回顾性分析2007年1月—2019年6月就诊于无锡市人民医院肺移植中心,经评估符合肺移植手术指征的54例终末期肺动脉高压患者的临床资料。根据是否手术分为手术组和非手术组。比较两组症状、体征、生化等临床资料以及术后生存期和生活质量评分,分析肺移植手术对患者生存率和生活质量的影响。生活质量评分采用SF-36评分表。结果共纳入符合肺移植手术指征的终末期肺动脉高压患者54例,其中36例完成肺移植手术,18例未手术。两组间性别、病程、病种、症状方面比较无统计学差异。非手术组的尿酸显著高于手术组(P=0.014),肺动脉收缩压显著低于手术组(P=0.046)。Kaplan-Meier生存曲线显示,手术组生存率显著高于非手术组(P=0.0087)。生活质量评分提示手术组患者的身体健康(physical component summary,PCS)评分和精神健康(mental component summary,MCS)评分均较手术前有提高(P<0.01),亦高于同期非手术组随访者(P<0.05)。术前体循环血压低、心功能差、氨基端B型利钠肽原高和尿酸高可能是导致肺动脉高压患者肺移植术后早期死亡的危险因素。结论肺移植手术可以有效提高终末期肺动脉高压患者的远期生存率,且患者术后的生活质量明显提高。Objective To assess the effects of lung transplantation(LT)in the treatment of end-stage pulmonary arterial hypertension(PAH)and evaluated its impact on quality of life(QoL).Methods A total of 54 patients with end-stage PAH admitted to the LT center of Wuxi People’s Hospital between January 2007 and June 2019 were retrospectively analyzed.The patients were divided into surgical and non-surgical groups.Clinical data were compared between the groups.The clinical data such as symptoms,signs,biochemistry,survival rate and quality of life were compared between the two groups.The effects of lung transplantation on survival and quality of life were analyzed.The quality of life was scored by SF-36 scale.Results A total of 54 patients with end-stage pulmonary arterial hypertension who met the indications for lung transplantation were enrolled.Among them,36 patients underwent lung transplantation and 18 patients did not undergo surgery.There were no statistical differences in gender,course of disease,disease type,symptoms between the two groups.The uric acid of the non-operation group was significantly higher than that of the lung transplantation group(P=0.014).The systolic pulmonary artery pressure(SPAP)of the non-operation group was significantly lower than that of the lung transplantation group(P=0.046).Kaplan-Meier survival curve showed that the survival rate of the operation group was higher than that of the non-operation group(P=0.0087).The quality of life assessment showed that after lung transplantation,the physical component summary and mental component summary scores of operation group were higher than those before operation(P<0.01),and also higher than non-operation group in the same period(P<0.05).Preoperative low systemic circulation blood pressure,poor cardiac function,high NT-proBNP and high uric acid may be the risk factors for early death of patients with pulmonary arterial hypertension after lung transplantation.Conclusions Lung transplantation can effectively improve survival and also QoL for patients

关 键 词：肺移植 终末期肺动脉高压 预后 生活质量 

分 类 号：R655.3[医药卫生—外科学]