中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2011年
2期
156-159
,共4页
李莉%王红月%宋来凤%王琳琳%郭勇%赵然旭%司文学%王清峙%张健%黄洁%赵红
李莉%王紅月%宋來鳳%王琳琳%郭勇%趙然旭%司文學%王清峙%張健%黃潔%趙紅
리리%왕홍월%송래봉%왕림림%곽용%조연욱%사문학%왕청치%장건%황길%조홍
心脏移植%冠状动脉狭窄%微血管病变
心髒移植%冠狀動脈狹窄%微血管病變
심장이식%관상동맥협착%미혈관병변
Heart transplantation%Coronary stenosis%Microvasculopathy
目的 分析心脏移植术后心内膜心肌活检中微血管的病变,以明确微血管病变与冠状动脉狭窄及患者预后的关系.方法 收集北京阜外心血管病医院2004年10月至2009年10月心脏移植术1年以上患者64例,有微血管的心肌活检278次列入研究范围.观察以往各次心肌活检微血管的组织学变化,并分析其与患者冠状动脉狭窄、术后心功能的关系.结果 微血管病变的患者年龄小于无微血管病变的患者[(40.7±15.9)岁比(49.4±8.7)岁,t=2.56,P＜0.05].微血管病变组平均排异级数明显高于无微血管病变组(0.83±0.39比0.37±0.32,t=4.96,P＜0.01).微血管病变组Ⅱ级以上排异次数高于无病变组[(0.84±0.16)次比(0.23±0.10)次,t=2.80,P＜0.01].患者以往各次急性细胞性排异的平均级数是微血管病变的危险因素(OR=3.40,95%可信区间4.62～193.07,P＜0.01),除此之外Quilty病变、受体心脏的冠状动脉粥样斑块、糖尿病均不是微血管病变的危险因素.微血管病变与移植术后冠状动脉狭窄和心功能减退无关(x2=0.94,P＞0.05和x2=2.90,P＞0.05).结论 微血管病变不是移植术后冠状动脉狭窄和心功能减退的预测因子,但仍是一种免疫反应,且是移植术后的新发事件.
目的 分析心髒移植術後心內膜心肌活檢中微血管的病變,以明確微血管病變與冠狀動脈狹窄及患者預後的關繫.方法 收集北京阜外心血管病醫院2004年10月至2009年10月心髒移植術1年以上患者64例,有微血管的心肌活檢278次列入研究範圍.觀察以往各次心肌活檢微血管的組織學變化,併分析其與患者冠狀動脈狹窄、術後心功能的關繫.結果 微血管病變的患者年齡小于無微血管病變的患者[(40.7±15.9)歲比(49.4±8.7)歲,t=2.56,P＜0.05].微血管病變組平均排異級數明顯高于無微血管病變組(0.83±0.39比0.37±0.32,t=4.96,P＜0.01).微血管病變組Ⅱ級以上排異次數高于無病變組[(0.84±0.16)次比(0.23±0.10)次,t=2.80,P＜0.01].患者以往各次急性細胞性排異的平均級數是微血管病變的危險因素(OR=3.40,95%可信區間4.62～193.07,P＜0.01),除此之外Quilty病變、受體心髒的冠狀動脈粥樣斑塊、糖尿病均不是微血管病變的危險因素.微血管病變與移植術後冠狀動脈狹窄和心功能減退無關(x2=0.94,P＞0.05和x2=2.90,P＞0.05).結論 微血管病變不是移植術後冠狀動脈狹窄和心功能減退的預測因子,但仍是一種免疫反應,且是移植術後的新髮事件.
목적 분석심장이식술후심내막심기활검중미혈관적병변,이명학미혈관병변여관상동맥협착급환자예후적관계.방법 수집북경부외심혈관병의원2004년10월지2009년10월심장이식술1년이상환자64례,유미혈관적심기활검278차렬입연구범위.관찰이왕각차심기활검미혈관적조직학변화,병분석기여환자관상동맥협착、술후심공능적관계.결과 미혈관병변적환자년령소우무미혈관병변적환자[(40.7±15.9)세비(49.4±8.7)세,t=2.56,P＜0.05].미혈관병변조평균배이급수명현고우무미혈관병변조(0.83±0.39비0.37±0.32,t=4.96,P＜0.01).미혈관병변조Ⅱ급이상배이차수고우무병변조[(0.84±0.16)차비(0.23±0.10)차,t=2.80,P＜0.01].환자이왕각차급성세포성배이적평균급수시미혈관병변적위험인소(OR=3.40,95%가신구간4.62～193.07,P＜0.01),제차지외Quilty병변、수체심장적관상동맥죽양반괴、당뇨병균불시미혈관병변적위험인소.미혈관병변여이식술후관상동맥협착화심공능감퇴무관(x2=0.94,P＞0.05화x2=2.90,P＞0.05).결론 미혈관병변불시이식술후관상동맥협착화심공능감퇴적예측인자,단잉시일충면역반응,차시이식술후적신발사건.
Objective Assess the clinical implication of microvasculopathy detected by endomyocardial biopsy samples in patients post heart transplantation. Methods Light microscopic evaluations were performed in 278 endomyocardial biopsies harvested from 64 patients post heart transplantation for more than one year, microvasculopathy was defined as stenotic endothelial and/or medial disease. Results The patients with stenotic microvasculopathy were younger than those without microvasculopathy (40. 7 ± 15.9 vs . 49.4 ± 8.7, P ＜ 0. 05 ). The mean score of acute cellular rejection (0. 83 ±0. 39 vs. 0. 37 ±0. 32, P ＜0. 01 ) and the numbers of≥grade II acute rejection (0. 84 ±0. 16 vs.0. 23 ± 0. 10, P ＜ 0. 01 ) were significantly greater in stenotic microvasculopathy group compared to those of non-stenotic group. Multivariate regression analysis confirmed that stenotic microvasculopathy is the independent risk factor for the mean acute rejection score (OR = 3.40, 95% CI, 4.62- 193.07, P ＜0. 01 ), but not for the Quilty lesion, coronary heart disease of donor, diabetes mellitus. Angiographically confirmed coronary vasculopathy and cardiac dysfunction ( x2 = 0. 94, P ＞ 0. 05 and x2 = 2.90, P ＞ 0. 05 )were similar between microvasculopathy group and non-microvasculopathy group. Conclusion Post heart transplantation microvasculopathy is an immune-mediated phenomenon and associated with higher mean score of acute cellular rejection and higher numbers of ≥ grade Ⅱ acute rejection but was not the prognostic risk factor for coronary vasculopathy and function reduction after heart transplantation.
