超声心动图评估的射血分数与心脏移植术后发生终末期肾病风险的关系  

Risk analysis of ejection fraction and end-stage renal disease after heart transplantation based on echocardiography evaluation

作　　者：杨会 刘静 邢丽丽[1] 蔡庆慧 YANG Hui;LIU Jing;XING Li-li;CAI Qing-hui(Ultrasound Imaging Department,Zhengzhou Seventh People′s Hospital,Zhengzhou 450000,Henan,China;不详)

机构地区：[1]郑州市第七人民医院超声影像科,河南郑州450000 [2]郑州市第七人民医院心脏移植中心,河南郑州450000

出　　处：《广东医学》2025年第2期300-304,共5页Guangdong Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20230734)。

摘　　要：目的探究超声心动图评估的射血分数在心脏移植术后发生终末期肾病(end-stage kidney disease,ESKD)中的预测价值。方法回顾性分析2020年2月至2023年4月在郑州市第七人民医院诊治的接受心脏移植术的100例患者的临床数据。按是否发生ESKD分成两组,收集并比较两组患者的基线资料、合并症、移植前肾小球滤过率eGFR、缺血时间、心力衰竭原因、围移植期生命支持情况、免疫抑制剂使用情况和超声心动图评估的左心室射血分数(left ventricular ejection fraction,LVEF)。通过单因素及多因素logistic回归分析影响ESKD发生的独立危险因素。结果ESKD组中糖尿病、高血压、慢性肾脏病和急性肾损伤的患者显著多于非ESKD组,差异均有统计学意义(均P<0.05)。ESKD组使用mTOR抑制剂和抗代谢药物的患者比例显著高于非ESKD组,差异均有统计学意义(均P<0.05)。超声心动图数据显示,ESKD组的患者LVEF为(48.7±7.5)%,显著低于非ESKD组的(58.0±9.3)%,差异有统计学意义(t=4.953,P<0.0001)。单因素分析显示,高血压、糖尿病、慢性肾脏病、急性肾损伤、mTOR抑制剂、抗代谢药物和LVEF与ESKD的发生显著相关(P<0.05)。LVEF<50%组的的中位无事件生存期为39个月,LVEF≥50%组的中位无事件生存期未达到,LVEF<50%组的的中位无事件生存期显著降低(HR=3.58,P<0.001)。多因素分析结果示mTOR抑制剂(HR=1.65,95%CI:1.41~2.37,P=0.031)、抗代谢药物(HR=1.51,95%CI:1.26~2.61,P=0.042)和LVEF(HR=2.43,95%CI:2.01~5.94,P<0.001)是发生ESKD的独立危险因素。结论mTOR抑制剂、抗代谢药物的使用以及超声心动图评估的射血分数降低会增加心脏移植术后ESKD风险。Objective To explore the predictive value of echocardiographically assessed left ventricular ejection fraction(LVEF)for the development of end-stage kidney disease(ESKD)after heart transplantation.Methods A retrospective analysis was conducted on the clinical data of 100 patients who underwent heart transplantation at Zhengzhou Seventh People′s Hospital between February 2020 and April 2023.Patients were divided into two groups based on whether they developed ESKD post-transplant.Baseline characteristics,comorbidities,pre-transplant estimated glomerular filtration rate(eGFR),ischemic time,causes of heart failure,perioperative life support measures,use of immunosuppressants,and LVEF measured by echocardiography were collected and compared between the groups.Univariate and multivariate logistic regression analyses were used to identify independent risk factors for ESKD.Results Patients in the ESKD group had a significantly higher prevalence of diabetes,hypertension,chronic kidney disease(CKD),and acute kidney injury(AKI)compared to the non-ESKD group(all P<0.05).The proportion of patients using mTOR inhibitors and antimetabolites was also significantly higher in the ESKD group than in the non-ESKD group(both P<0.05).Echocardiographic data showed that the mean LVEF in the ESKD group was(48.7±7.5)%,significantly lower than(58.0±9.3)%in the non-ESKD group(t=4.953,P<0.0001).Univariate analysis revealed that hypertension,diabetes,CKD,AKI,use of mTOR inhibitors,use of antimetabolites,and reduced LVEF were significantly associated with the occurrence of ESKD(P<0.05).Patients with LVEF<50%had a median event-free survival of 39 months,while the median event-free survival for those with LVEF≥50%was not reached,indicating significantly reduced survival in the LVEF<50%group(HR=3.58,P<0.001).Multivariate analysis identified the use of mTOR inhibitors(HR=1.65,95%CI:1.41-2.37,P=0.031),use of antimetabolites(HR=1.51,95%CI:1.26-2.61,P=0.042),and reduced LVEF(HR=2.43,95%CI:2.01-5.94,P<0.001)as independent risk factors for ESKD.

关 键 词：超声心动图 心脏移植 射血分数 

分 类 号：R540.45[医药卫生—心血管疾病] R692.5[医药卫生—内科学]