老龄原位心脏移植受者的特点、预后及其相关影响因素单中心分析  

Characteristics,outcomes and its relative risk factors in elderly recipients of heart transplantation:a single-center experience

作　　者：郑珊珊 郑哲 黄洁 廖中凯 张琳 房晓楠 刘盛 Zheng Shanshan;Zheng Zhe;Huang Jie;Liao Zhongkai;Zhang Lin;Fang Xiaonan;Liu Sheng(Department of Cardiac Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China;Department of Heart Failure&Heart Transplant,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院阜外医院心脏外科,北京100037 [2]中国医学科学院阜外医院心力衰竭与移植病房,北京100037

出　　处：《中华器官移植杂志》2024年第3期167-174,共8页Chinese Journal of Organ Transplantation

基　　金：创新工程-中国医学科学院临床与转化医学研究专项(2022-I2M-C&T-B-038)。

摘　　要：目的探讨老龄心脏移植受者的数量变化趋势和预后情况,并对相关危险因素进行分析。方法回顾性分析2004年6月至2021年12月在中国医学科学院阜外医院进行心脏移植的1044例年龄≥18岁受者的临床资料及年龄分布情况。根据心脏移植时受者年龄是否大于60岁,分为老龄组(≥60岁,877例)和非老龄组(<60岁,157例),再将老龄组受者按<65岁(107例)及≥65岁(50例)进行亚组分析,分别比较上述各组供者的基线资料及受者的基线资料、临床资料、术后院内及术后1年病死率和远期生存率。进一步分析非老龄组、老龄组中<65岁和老龄组中≥65岁受者的远期生存差异。采用logistic回归模型和Cox比例风险回归模型分析全部纳入研究受者心脏移植术后短期病死率和累积生存率的相关危险因素。采用Kaplan-Meier法绘制生存曲线,比较采用Log-rank检验。采用多变量logistic回归模型对短期病死率的相关危险因素进行分析,采用多变量Cox比例风险回归模型对累积生存率的相关危险因素进行分析,在校正其他混杂因素的前提下,以确定受者年龄对心脏移植术后生存的影响。结果本中心每年接受移植手术的老龄受者例数均有所增加,而成年心脏移植受者的平均年龄及老龄受者的平均年龄相对稳定。本研究的中位随访时间为6.5年。基线资料方面,老龄组受者与非老龄组男性[84.7%(113/157)比77.5%(687/877)],有高血压[20.4%(32/157)比8.9%(79/877)]、吸烟[47.1%(74/157)比36.1%(320/877)]、糖尿病史[33.8%(53/157)比14.7%(130/877)],术前植入转复除颤器/心脏再同步化治疗起搏器/心脏再同步化治疗除颤器(ICD/CRT/CRT-D)比例[28.0%(44/157)比18.0%(160/877)]和术前肌酐[(105.3±25.3)μmol/L比(96.8±35.0)μmol/L]、IMPACT评分[(6.9±2.4)分比(4.2±2.9)分]、血清总胆红素[19.7(13.6,30.3)μmol/L比23.7(15.8,36.8)μmol/L]、平均肺动脉压[(26.0±10.3)mmHg比(29.7±11.0)mmHg(1 mmHg=0.133 kPa)Objective To explore the trends and outcomes for heart transplantation(HT)in elderly recipients and further examine the related risk factors.Methods Between June 2004 and December 2021,retrospective review was conducted for the relevant clinical data and age distribution of 1044 HT recipients aged≥18 year at Fuwai Hospital.The study population was assigned into two groups of elder(≥60 year,n=877)and non-elder(<60 year,n=157).Subgroup analysis was made between recipients aged<65 year(n=107)and those aged≥65 year(n=50)in elder group.Baseline demographic profiles,clinical data,in-hospital and one-year post-transplant mortality and long-term survival were compared between two groups.Then a further comparison of long-term survival was conducted among the groups of non-elder,elder aged<65 year and elder aged≥65 year.Cox proportional risk regression and multivariate Logistic regression models were utilized for examining the relevant risk factors for cumulative survival rate and short-term mortality.Kaplan-Meier analysis was employed for plotting survival curves and Log-rank test for comparison.Multivariate Cox proportional risk regression model was utilized for examining the relevant risk factors for cumulative survival rate and multivariate Logistic regression model for analyzing the relevant risk factors for short-term mortality.After adjusting for other confounding factors,the impact of recipient age on survival post-HT was determined.Results The number of elderly HT recipients spiked annually at our center while average age of adult recipients and average age of elderly recipients have remained relatively constant.The median follow-up period was 6.5 years.Regarding baseline data,statistically significant differences existed in ratio of males[84.7%(113/157)vs 77.5%(687/877)],hypertension history[20.4%(32/157)vs 8.9%(79/877)],smoking history[47.1%(74/157)vs 36.1%(320/877)],diabetic history[33.8%(53/157)vs 14.7%(130/877)],preoperative ICD/CRT/CRT-D implantation[28.0%(44/157)vs 18.0%(160/877)],value of creatinin

关 键 词：心脏移植 老年人 受者 生存分析 危险因素 

分 类 号：R654.2[医药卫生—外科学]