心脏移植术前血N端B型利钠肽原水平与术后早期受者存活率的关系

Relationship between pre-operative N-terminal-pro-brain natriuretic levels and early survival of HT recipients

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-proBNPJk平将284例患者分为≤5000nmol／L组（≤5000组，237例）和〉5000nmol／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）mmHg（1mmI Hg=0．133kPa），明显高于≤5000组的（21．4±9．2）mmHg（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、ECM0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（〉5000nmol／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。

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） mrnHg, noticeably higher than in 45000 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 45000 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 ）5000 nmol/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.