肾移植状态儿童心脏结构和功能评估及分析

Evaluation and analysis of cardiac structure and function in pediatric patients after kidney transplantation

  • 摘要:
    目的 探讨儿童肾移植术后1年内心脏结构和功能。
    方法 回顾性选取2021年2月至2024年12月在中山大学附属第一医院心血管儿科住院的同种异体肾移植术后1年内肾功能正常的儿童50例作为肾移植组,选取年龄、性别匹配的健康儿童50例作为对照组。均进行超声心动图检查,对比分析两组一般特征及超声心动图检查结果。分析肾移植组儿童的左心室结构。
    结果 肾移植术后时间为3(2,6)个月,46例进行了移植前透析,透析时间为9(5,13)个月。超声心动图结果显示,两组心脏结构、收缩及舒张功能差异均有统计学意义(均为P<0.05)。但两组左心室射血分数(LVEF)均处于正常范围内。肾移植组42%存在左心室肥厚,52%存在左心室向心性重塑。
    结论 大部分儿童肾移植术后仍存在心脏结构和收缩、舒张功能障碍,相比传统超声指标,二维斑点追踪超声心动图在评价肾移植后儿童心脏功能方面更为敏感。利用超声心动图对肾移植状态儿童进行规律的监测,有利于早期发现心脏结构与功能改变,从而及时干预,提高生存质量。

     

    Abstract:
    Objective To investigate the cardiac structure and function within one year after kidney transplantation in children.
    Methods A total of 50 children with normal renal function within one year after allogeneic kidney transplantation hospitalized in the Department of Pediatric Cardiology, the First Affiliated Hospital of Sun Yat-sen University from February 2021 to December 2024 were retrospectively enrolled as the kidney transplantation group. Another 50 healthy children matched for age and gender were recruited as the control group. Echocardiography was performed in all subjects. General clinical characteristics and echocardiographic parameters were compared between the two groups, and left ventricular structure was analyzed in children of the kidney transplantation group.
    Results The duration after kidney transplantation was 3 (2, 6) months. Forty-six patients received pre-transplant dialysis with a dialysis duration of 9 (5, 13) months. Echocardiographic findings revealed statistically significant intergroup differences in cardiac structure, systolic function and diastolic function (all P<0.05), while left ventricular ejection fraction (LVEF) remained within normal limits in both groups. In the kidney transplantation group, left ventricular hypertrophy was detected in 42% of patients, and concentric left ventricular remodeling was observed in 52% of patients.
    Conclusions Most children still present abnormalities in cardiac structure as well as systolic and diastolic dysfunction after kidney transplantation. Compared with conventional echocardiographic indices, two-dimensional speckle-tracking echocardiography is more sensitive for evaluating cardiac function in pediatric kidney transplant recipients. Regular echocardiographic surveillance for children with kidney transplantation facilitates early identification of alterations in cardiac structure and function, enabling timely intervention and improvement of quality of life.

     

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