CAJ | 학술논문

目的总结2013年全国心脏移植网络注册系统实时上报的基本数据,探讨我国心脏移植的现状.方法 2013年我国17个移植中心共进行心脏移植231例.采用Logistic单因素和多因素回归分析影响我国心脏移植受者院内死亡的危险因素.对北京阜外医院1家中心2004年6月至2013年12月的398例受者(随访率100％)采用Kaplan-Meier方法统计中长期存活率.采用Cox生存分析的方法分析影响我国心脏移植受者中长期存活的危险因素.结果 231例受者的平均住院时间为24 d,院内死亡25例,总死亡率为10.8％(25/231),其中手术量最大的3家中心平均院内死亡率2.2％.多因素Logister分析结果表明,仅术前群体反应性抗体(PRA)阳性是影响心脏移植受者院内死亡的危险因素(比值比=12.435,95％可信区间1.369～112.938,P=0.025).北京阜外医院398例心脏移植受者的随访时间中位数为1383 d,受者术后1、3、5和7年存活率分别为94.7％、91.6％、88.0％和82.6％.单因素和多因素COX回归分析证实,术前心脏原发病(心肌病与非心肌病,P＜0.01)、术前合并慢性阻塞性肺疾病(P＜0.01)、术前总胆红素水平(P＜0.05)及术前血肌酐水平(P＜0.01)是影响心脏移植受者术后中长期存活的危险因素.结论 2013年我国心脏移植总体手术例数有所提高,手术量大的心脏移植中心受者存活状况良好;部分移植中心的数据上报完整度有待进一步提高.
목적 총결2013년전국심장이식망락주책계통실시상보적기본수거,탐토아국심장이식적현상.방법 2013년아국17개이식중심공진행심장이식231례.채용Logistic단인소화다인소회귀분석영향아국심장이식수자원내사망적위험인소.대북경부외의원1가중심2004년6월지2013년12월적398례수자(수방솔100％)채용Kaplan-Meier방법통계중장기존활솔.채용Cox생존분석적방법분석영향아국심장이식수자중장기존활적위험인소.결과 231례수자적평균주원시간위24 d,원내사망25례,총사망솔위10.8％(25/231),기중수술량최대적3가중심평균원내사망솔2.2％.다인소Logister분석결과표명,부술전군체반응성항체(PRA)양성시영향심장이식수자원내사망적위험인소(비치비=12.435,95％가신구간1.369～112.938,P=0.025).북경부외의원398례심장이식수자적수방시간중위수위1383 d,수자술후1、3、5화7년존활솔분별위94.7％、91.6％、88.0％화82.6％.단인소화다인소COX회귀분석증실,술전심장원발병(심기병여비심기병,P＜0.01)、술전합병만성조새성폐질병(P＜0.01)、술전총담홍소수평(P＜0.05)급술전혈기항수평(P＜0.01)시영향심장이식수자술후중장기존활적위험인소.결론 2013년아국심장이식총체수술례수유소제고,수술량대적심장이식중심수자존활상황량호;부분이식중심적수거상보완정도유대진일보제고.
Objective To summarize and analyze the primary data from China Heart Transplant Registry in 2013 in order to explore the current status of heart transplantation in Chink Method Seventeen transplant centers have conducted 231 cases of heart transplantation in the year 2013.We analyzed the preoperative risk factors which impacted the survival of heart transplant recipients by using univariate and multivariate logistic regression analysis.And long-term survival of the 398 heart recipients from Beijing Fu Wai Hospital,who were followed up from June 2004 to December 2013 (follow-up rate was 100 ％) was calculated by the Kaplan-Meier method.The risk factors for long-term survival of heart transplant recipients were calculated by the COX survival analysis methods.Result The mean hospital stay of the 231 recipients was 24 days.There were 25 cases who died in hospital,and the total mortality was 10.8 ％ (25/231),while the average in-hospital mortality was 2.2 ％ in the three largest centers.By using the univariate and multivariate logistic regression analysis,we found that recipients" positive PRA was the only preoperative risk factor which impacted the in-hospital mortality.(OR=12.435,95％ CI 1.369～ 112.938,P =0.025).The median follow-up time of the 398 heart transplant recipients from Beijing Fu Wai Hospital was 1383 days,and the 1-,3-,5-and 7-year survival rate was 94.7％,91.6％,88.0％ and 82.6％ respectively.The univariate and multivariate COX regression analysis revealed that preoperative primary diseases (coronary heart disease vs.cardiomyopathy,P ＜ 0.01),the history of chronic obstructive pulmonary disease (P ＜ 0.01),the preoperative total bilirubin level (P＜0.05) and serum creatinine level (P＜ 0.01) were risk factors affecting long-term postoperative survival.Conclusion In China the number of heart transplants has increased in 2013.The survival rate of recipients is high in large heart transplant centers.The integrity of registration data needs to be further improved in some centers.