Effect of body mass index of recipients on early prognosis after lung transplantation
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摘要:
目的 探讨受者体质量指数（BMI）对肺移植术后早期预后的影响。 方法 回顾性分析307例肺移植受者的临床资料，根据受者术前BMI水平分为低BMI组（BMI<18.5 kg/m2，114例）、正常BMI组（18.5 kg/m2≤BMI<24 kg/m2，145例）和高BMI组（BMI≥24.0 kg/m2，48例）。比较各组受者的一般资料，包括年龄、性别、血型、BMI、术前合并症、术前是否肺动脉高压、术中是否应用体外膜肺氧合（ECMO）。使用Kaplan-Meier法估计受者生存率并绘制生存曲线，采用log-rank检验比较生存率差异。使用多因素Cox回归分析不同BMI组受者肺移植术后30 d、90 d和180 d死亡风险。 结果 各组受者年龄、性别差异均有统计学意义（均为P<0.05）。在肺移植术后180 d生存分析中，不同BMI组受者的生存率差异有统计学意义（P<0.05）。多因素Cox回归分析结果显示，高BMI组受者肺移植术后90 d的死亡风险是正常BMI组的2.295倍[风险比（HR）2.295，95%可信区间（CI） 1.064～4.947，P=0.034]；高BMI组受者肺移植术后180 d的死亡风险是正常BMI组的2.783倍（HR 2.783，95%CI 1.333～5.810，P=0.006），低BMI组的死亡风险是正常BMI组的2.181倍（HR 2.181，95%CI 1.124～4.232，P=0.021）。 结论 相对于正常BMI的受者，术前受者高BMI与低BMI均增加肺移植术后早期死亡风险，术前尽量将受者BMI调整至正常范围有助于改善肺移植受者早期预后。 Abstract:Objective To evaluate the effect of body mass index (BMI) on early prognosis of the recipients after lung transplantation. Methods Clinical data of 307 lung transplant recipients were retrospectively analyzed. According to preoperative BMI, all recipients were divided into the low (BMI <18.5 kg/m2, n=114), normal (18.5 kg/m2≤BMI <24 kg/m2, n=145) and high (BMI≥24.0 kg/m2, n=48) BMI groups, respectively. Baseline data including age, sex, blood type, BMI, preoperative complications, preoperative pulmonary hypertension, and intraoperative use of extracorporeal membrane oxygenation (ECMO) of all recipients were compared among three groups. The survival rate of all recipients was estimated by Kaplan-Meier curve and the survival curve was delineated. The differences of survival rate were analyzed by log-rank test. The 30-, 90- and 180-d mortality risk of all recipients after lung transplantation in different BMI groups was compared by multivariate Cox regression analysis. Results There were significant differences in age and sex of recipients among three groups (both P<0.05). There was a significant difference regarding the 180-d survival rate after lung transplantation among different BMI groups (P<0.05). Multivariate Cox regression analysis showed that the 90-d mortality risk after lung transplantation in the high BMI group was 2.295 times higher than that in the normal BMI group [hazard ratio (HR) 2.295, 95% confidence interval (CI) 1.064-4.947, P=0.034]. In the high BMI group, the 180-d mortality risk after lung transplantation was 2.783 times higher compared with that in the normal BMI group (HR 2.783, 95%CI 1.333-5.810, P=0.006), and the 180-d mortality risk in the low BMI group was 2.181 times higher than that in the normal BMI group (HR 2.181, 95%CI 1.124-4.232, P=0.021). Conclusions Compared with the recipients with normal BMI, their counterparts with high and low preoperative BMI have higher mortality risk early after lung transplantation. Adjusting preoperative BMI to normal range contributes to improving early prognosis of lung transplant recipients. -
Key words:
- Body mass index /
- Lung transplantation /
- Recipient /
- Early prognosis /
- Survival rate /
- Primary graft failure /
- Obesity /
- Malnutrition
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图 1 3组肺移植受者术后生存曲线
Figure 1. Survival curves of lung transplant recipients after surgery among three groups
表 1 3组受者一般资料比较
Table 1. Comparison of general data of recipients among three groups
变量 低BMI组
（n=114例）正常BMI组（n=145例） 高BMI组
（n=48例）统计值 P值 年龄（$\bar x $±s，岁） 51±13 57±11 59±10 11.806 <0.001 性别[n（%）] 8.588 0.014 男 84（73.7） 126（86.9） 35（72.9） 女 30（26.3） 19（13.1） 13（27.1） 血型[n（%）] 6.252 0.396 A 30（26.3） 52（35.9） 15（31.2） B 35（30.7） 32（22.1） 12（25.0） O 38（33.3） 46（31.7） 19（39.6） AB 11（9.6） 15（10.3） 2（4.2） Rh[n（%）] 1.690 0.430 阳性 113（99.1） 145（100） 48（100） 阴性 1（0.9） 0 0 术前合并症[n（%）] 2.060 0.357 有 105（92.1） 133（91.7） 41（85.4） 否 9（7.9） 12（8.3） 7（14.6） 术前是否肺动脉高压[n（%）] 3.421 0.181 是 83（72.8） 91（62.8） 29（60.4） 否 31（27.2） 54（37.2） 19（39.6） 术中是否使用ECMO[n（%）] 1.703 0.427 是 86（75.4） 117（80.7） 35（72.9） 否 28（24.6） 28（19.3） 13（27.1） 
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表 2 肺移植术后30 d生存结局的多因素分析
Table 2. Multivariate analysis of 30 d survival outcome after lung transplantation
变量 回归系数 标准误 Wald χ2值 HR① 95%CI② P值 高BMI组 0.510 0.428 1.192 1.665 0.720～3.849 0.233 低BMI组 0.050 0.402 0.126 1.052 0.479～2.311 0.900 性别（女） 0.469 0.384 1.222 1.598 0.753～3.389 0.222 年龄 0.015 0.015 1.029 1.016 0.986～1.046 0.303 注：①HR为风险比。
②CI为可信区间。
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表 3 肺移植术后90 d生存结局的多因素分析
Table 3. Multivariate analysis of 90 d survival outcome after lung transplantation
变量 回归系数 标准误 Wald χ2值 HR 95%CI P值 高BMI组 0.831 0.392 2.119 2.295 1.064～4.947 0.034 低BMI组 0.453 0.363 1.249 1.573 0.773～3.201 0.212 性别（女） 0.454 0.337 1.346 1.575 0.813～3.052 0.178 年龄 0.014 0.013 1.026 1.014 0.988～1.040 0.305
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表 4 肺移植术后180 d生存结局的多因素分析
Table 4. Multivariate analysis of 180 d survival outcome after lung transplantation
变量 回归系数 标准误 Wald χ2值 HR 95%CI P值 高BMI组 1.024 0.375 2.726 2.783 1.333～5.810 0.006 低BMI组 0.780 0.338 2.306 2.181 1.124～4.232 0.021 性别（女） 0.443 0.305 1.454 1.557 0.857～2.829 0.146 年龄 0.011 0.012 0.897 1.011 0.988～1.034 0.370
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