肝移植术前代谢综合征对受者术后新发心房颤动的影响

Impact of pre-transplant metabolic syndrome on new-onset postoperative atrial fibrillation in adult liver transplantation

目的 探讨肝移植术前合并代谢综合征（metabolic syndrome,MS）对受者术后新发心房颤动（postoperative atrial fibrillation,POAF）的影响.方法 选取2010年1月至2015年12月在加州大学洛杉矶分校（UCLA）医学中心接受首次肝移植的成人（年龄≥18岁）受者为研究对象,经医院伦理委员会同意,收集相关临床资料,MS采用2009年全球统一定义的新标准,POAF定义为术后30天内新发的心房颤动,而患者术前没有慢性持续性心房颤动.将肝移植受者分为MS组和非MS组,比较两组POAF的发生情况.应用单因素和多因素回归分析POAF的危险因素是否与MS有关.结果 842例肝移植受者,术前MS发生率是29.4％ （247/842）.有71例受者发生POAF,其发生率8.4％（71/842）.MS组POAF的发生率14.6％ （36/247）明显高于非MS组的5.9％ （35/598,P＜0.01）.多因素Logistic回归分析表明,MS是肝移植受者发生POAF的独立危险因素（OR值2.290,95％可信区间1.342～3.907）,其他危险因素包括年龄、术前心房颤动史和基线肌酐水平（OR值分别为1.030,2.479和1.380,P＜0.05）.结论 术前合并MS是肝移植受者发生POAF的独立危险因素,应当引起重视,提高认识,加强管理.

Objective To investigate the effect of pre-transplant metabolic syndrome （MS） on new-onset postoperative atrial fibrillation （POAF） in adult liver transplant recipients.Methods Adult patients （age ≥18 years） who underwent primary liver transplantation at the UCLA Medical Center between January 2009 and December 2015 were retrospectively reviewed.Clinical data were collected after obtaining institutional review board approval.MS was defined according to the 2009 harmonized definition.POAF was defined as new-onset atrial fibrillation within 30 days after liver transplantation in patients without chronic persistent atrial fibrillation.Patients were divided into two groups：MS and non-MS groups.Incidence of POAF was compared between two groups.Then,univariate and multivariate logistic regression analyses were performed to assess the relationships between MS and POAF.Results Of 842 patients,prevalence of pre-transplant MS was 29.4%.POAF occurred in 71 patients （8.4%）.The incidence of POAF between MS and non-MS groups significantly differed （14.6% vs.5.9%,P〈0.01）.The logistic regression analysis revealed that the presence of MS was significantly associated with POAF [odd ratios （OR） 2.290,95% CI 1.342-3.907].Other risk factors include recipient age,prior history of AF,and preoperative baseline creatinine （OR 1.030,2.479 and 1.380,respectively,all P〈0.05）.Conclusion The presence of pre-transplant MS is an independent risk factor for POAF in liver transplantation patients.Pre-transplant MS should be properly diagnosed and managed before transplantation.