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心脏移植术后移植物血管病:阜外医院单中心长期随访结果总结

郑珊珊, 郑哲, 宋云虎, 等. 心脏移植术后移植物血管病:阜外医院单中心长期随访结果总结[J]. 器官移植, 2022, 13(2): 206-212. doi: 10.3969/j.issn.1674-7445.2022.02.008
引用本文: 郑珊珊, 郑哲, 宋云虎, 等. 心脏移植术后移植物血管病:阜外医院单中心长期随访结果总结[J]. 器官移植, 2022, 13(2): 206-212. doi: 10.3969/j.issn.1674-7445.2022.02.008
Zheng Shanshan, Zheng Zhe, Song Yunhu, et al. Cardiac allograft vasculopathy after heart transplantation: summary of a single-center long-term follow-up experience in Fuwai Hospital[J]. ORGAN TRANSPLANTATION, 2022, 13(2): 206-212. doi: 10.3969/j.issn.1674-7445.2022.02.008
Citation: Zheng Shanshan, Zheng Zhe, Song Yunhu, et al. Cardiac allograft vasculopathy after heart transplantation: summary of a single-center long-term follow-up experience in Fuwai Hospital[J]. ORGAN TRANSPLANTATION, 2022, 13(2): 206-212. doi: 10.3969/j.issn.1674-7445.2022.02.008

心脏移植术后移植物血管病:阜外医院单中心长期随访结果总结

doi: 10.3969/j.issn.1674-7445.2022.02.008
基金项目: 

国家重点研发计划项目 2016YFC1300900

详细信息
    作者简介:
    通讯作者:

    刘盛,男,1975年生,博士,主任医师,研究方向为心脏移植、冠状动脉粥样硬化性心脏病的外科治疗、心脏瓣膜病等,Email:liusheng@fuwai.com

  • 中图分类号: R617, R541

Cardiac allograft vasculopathy after heart transplantation: summary of a single-center long-term follow-up experience in Fuwai Hospital

More Information
  • 摘要:   目的  总结心脏移植术后心脏移植物血管病变(CAV)的发生情况及其对患者长期存活的影响。  方法  回顾性分析1 006例心脏移植受者的临床资料,48例CAV患者中4例因缺失影像学证据未纳入分析。1 002例受者中,根据CAV发生情况分为CAV组(44例)和无CAV组(958例)。总结CAV的发生情况,比较两组患者的临床资料,分析CAV患者的影像学诊断方式及冠状动脉病变情况、药物治疗及合并症情况、术后生存情况及死亡原因。  结果  1 006例心脏移植受者中共48例发生CAV,发生率为4.77%。与无CAV组比较,CAV组患者术前吸烟史、术前高血压病史、原发病为冠状动脉疾病及围手术期感染的比例均较高(均为P < 0.05)。44例通过影像学诊断CAV的患者中,24例通过冠状动脉CT血管造影(CTA)诊断CAV,4例通过冠状动脉造影(CAG)诊断CAV,16例联合使用冠状动脉CTA及CAG诊断CAV。44例患者中,CAV 1级占45%(20/44),CAV 2级占30%(13/44),CAV 3级占25%(11/44)。全部患者术后长期使用他汀类药物治疗,有20例患者应用抗血小板药物治疗。44例CAV患者中,11例患者接受经皮冠状动脉介入治疗,6例患者接受再次心脏移植,共8例患者死亡。Kaplan-Meier生存分析结果显示,CAV组和无CAV组患者术后长期生存率差异无统计学意义(P > 0.05),但在诊断CAV后(术后6~7年),患者的生存率呈下降的趋势;CAV 1级、CAV 2级和CAV 3级患者术后长期生存率差异无统计学意义(P > 0.05),但即使是病变较轻的CAV 1级患者,术后远期生存率也呈下降趋势。  结论  CAV是心脏移植术后常见且棘手的并发症,诊断CAV后患者长期生存率呈下降趋势。应提高对CAV的认识,早预防、早诊断、早治疗,以提高患者心脏移植术后的长期生存率。

     

  • 图  1  两组患者心脏移植术后生存曲线

    Figure  1.  Survival curves of patients after heart transplantation in two groups

    图  2  不同严重程度的CAV患者心脏移植术后生存曲线

    Figure  2.  Survival curves of patients with different severity of CAV after heart transplantation

    表  1  两组患者的临床资料比较

    Table  1.   Comparison of clinical data of patients between two groups

    指标 CAV组(n=44) 无CAV组(n=958) P
    受者资料
        年龄(x±s,岁) 42±12 46±14 0.06
        性别[n(%)]
          男 37(84) 747(78) 0.33
          女 7(16) 211(22)
        体质量指数(x±s,kg/m2 22±4 22±4 0.73
        吸烟史[n(%)] 24(55) 329(34) < 0.01
        糖尿病病史[n(%)] 8(18) 156(16) 0.74
        高血压病史[n(%)] 7(16) 95(10) 0.01
        原发病[n(%)] < 0.01
          原发性心肌病 25(57) 694(72)
          冠状动脉疾病 13(30) 139(15)
          瓣膜病 2(5) 35(4)
          先天性心脏病 2(5) 12(1)
          其他 2(5) 78(8)
    供者资料
        年龄(x±s,岁) 32±9 33±10 0.57
        冷缺血时间(x±s,min) 315±140 303±116 0.18
    围手术期资料
        使用机械辅助[n(%)] 5(11) 170(18) 0.14
        感染[n(%)] 14(32) 127(13) < 0.01
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出版历程
  • 收稿日期:  2021-12-19
  • 网络出版日期:  2022-03-18
  • 刊出日期:  2022-03-15

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