CAJ | 학술논문

目的探讨心脏移植术前血N端B型利尿钠肽原(NT-proBNP)水平与术后早期受者存活率的关系.方法采用免疫法测定284例拟接受心脏移植的心力衰竭患者移植前血NT-proBNP水平,按NT-proBNP水平将284例患者分为≤5000 nmol/L组(≤5000组,237例)和＞5000 nmol/L组(＞5000组,47例),比较两组受者的术前一般情况、不同原发病者的NT-proBNP水平、两组围手术期体外膜肺氧合(ECMO)技术应用率及死亡率.采用Kaplan-Meier法计算两组受者1年存活率.结果＞5000组术前肺毛细血管楔压为(25.1±7.4)mm Hg(1 mm Hg=0.133 kPa),明显高于≤5000组的(21.4±9.2)mm Hg(P＜0.05)；心脏指数为(1.8±0.5)L·min-1·m-2,明显低于≤5000组的(2.1±0.6)L·min-1·m-2 (P＜0.05).＞5000组围手术期需用ECMO支持者占14.9％(7/47),ECMO相关死亡率为71.4％(5/7),1年存活率为91.3％；≤5000组围手术期需用ECMO支持者占6.8％(16/237),ECMO相关死亡率为12.5％(2/16),1年存活率为96.9％,2个组ECMO应用率、ECMO相关死亡率以及受者1年存活率的差异均有统计学意义(P＜0.05).结论术前血NT-proBNP水平较高(＞5000 nmol/L)者围手术期ECMO应用率和1年死亡率均较高；术前测定血NT-proBNP水平有助于心脏移植时机的把握.
목적 탐토심장이식술전혈N단B형이뇨납태원(NT-proBNP)수평여술후조기수자존활솔적관계.방법 채용면역법측정284례의접수심장이식적심력쇠갈환자이식전혈NT-proBNP수평,안NT-proBNP수평장284례환자분위≤5000 nmol/L조(≤5000조,237례)화＞5000 nmol/L조(＞5000조,47례),비교량조수자적술전일반정황、불동원발병자적NT-proBNP수평、량조위수술기체외막폐양합(ECMO)기술응용솔급사망솔.채용Kaplan-Meier법계산량조수자1년존활솔.결과 ＞5000조술전폐모세혈관설압위(25.1±7.4)mm Hg(1 mm Hg=0.133 kPa),명현고우≤5000조적(21.4±9.2)mm Hg(P＜0.05)；심장지수위(1.8±0.5)L·min-1·m-2,명현저우≤5000조적(2.1±0.6)L·min-1·m-2 (P＜0.05).＞5000조위수술기수용ECMO지지자점14.9％(7/47),ECMO상관사망솔위71.4％(5/7),1년존활솔위91.3％；≤5000조위수술기수용ECMO지지자점6.8％(16/237),ECMO상관사망솔위12.5％(2/16),1년존활솔위96.9％,2개조ECMO응용솔、ECMO상관사망솔이급수자1년존활솔적차이균유통계학의의(P＜0.05).결론 술전혈NT-proBNP수평교고(＞5000 nmol/L)자위수술기ECMO응용솔화1년사망솔균교고；술전측정혈NT-proBNP수평유조우심장이식시궤적파악.
Objective To assess the correlation between pre-operative N-terminal-pro-brain natriuretic levels and early survival rate among heart transplantion (HT) recipients in a single Chinese center.Methods According to the pre-operative NT-proBNP level of 284 HT recipients,the recipients were divided into two distinctive groups,≤5000 nmol/L group (237 cases) and ＞5000 nmol/L group (47 cases).The baseline characteristics and mortality for recipients with different primary cardiac diseases and on extracorporeal membrane oxygenation (ECMO) support were compared.Kaplan Meier method was used to calculate the 1-year survival rate of the two groups.Results The pre-operative NT-proBNP ＞5000 nmol/L group had an average pulmonary capillary wedge pressure of (25.1 ± 7.4)mmHg,noticeably higher than in ≤5000 nmol/L group [(21.4 ± 9.2) mmHg,P＜0.05].At the same time,the cardiac index (CI) in ＞5000 nmol/L group was (1.8 ± 0.5) L·min-1·m-2,significantly lower than in ≤5000 nmol/L group [(2.1 ± 0.6) L·min-1 ·m-2,P＜0.05].14.9％(7/47) of recipients in ＞5000 nmol/L group used ECMO support,and the corresponding ECMO-related morbidity was 71.4％ (5/7) and 1-year survival rate was 91.3％.6.8％ (16/237) of recipients in ≤ 5000 nmol/L group used ECMO support and the corresponding ECMO-related morbidity was 12.5％ (2/16) and 1-year overall survival rate was 96.9％.There was statistically significant difference in the ECMO usage,ECMO-related mortality rate and 1-year survival rate between the two groups (P＜0.05).Conclusion Recipients with pre-operative NT-proBNP ＞5000nmol/L have higher peri-operative ECMO-related morbidity and 1-year death rate.So determination of pre-operative NT-proBNP level may be beneficial to the timing of cardiac transplantation.