老年肝移植受者肝硬化心肌病的临床特征及预后分析

Clinical Features of Cirrhotic Cardiomyopathy in Elderly Liver Transplant Recipients and Prognosis Analysis

目的研究老年肝移植受者肝硬化心肌病的患病率、临床特征及其预后。方法纳入上海交通大学医字院附属仁济医院2012年1月—2015年6月行原位肝移植的老年(年龄≥60岁)肝移植受者,排除同时患有心脏病的患者。依据患者术前心脏超声及心电图检查结果,在确诊为肝硬化的患者中,存在收缩或舒张功能不全的患者诊断为肝硬化心肌病(cirrhotic cardiomyopathy,CCM),QTc间期>440 ms的患者诊断为QTc间期延长。对所有患者进行随访。结果共纳入63例以男性(47例,75%)为主的老年肝移植受者,平均年龄(64.0±9.0)岁。27例(43%)患者诊断为CCM,29例(46%)患者诊断为QTc间期延长。与QTc间期正常的患者相比,QTc间期延长的患者其Child-Pugh评分得分(P=0.003)、MELD评分得分(P=0.008)、胆汁酸(P=0.01)、胆红素(P=0.007)及INR(P=0.02)较高,而纤维蛋白原水平较低(P=0.04)。MELD评分得分是QTc间期的独立相关因素(R=0.32,R^2=0.1,P=0.007)。术后平均随访(24.7±10.3)个月,Kaplan-Meier分析显示,与QTc间期正常患者相比,QTc延长患者的术后生存率较低(P=0.047,风险比为2.69)。结论老年肝移植受者中CCM及QTc间期延长的患病率分别为43%和46%,伴有QTc间期延长的患者其肝病较严重,且预后较差。

Objective To investigate the prevalence,clinical features and prognosis of cirrhotic cardiomyopathy(CCM)in elderly liver transplant recipients.Methods Elderly liver transplant recipients(≥60years old)with no other known cardiac diseases,who had received orthotopic liver transplantation within the period fromJanuary,2012to June,2015in Renji Hospital,were included in this study;based on the results of echocardiography and ECG,diagnosis of CCM was made to cirrhotic patients with systolic or diastolic dysfunction while diagnosis of QTc interval prolongation was made to patients with QTc interval>440ms;all the patients were followed up.Results A total of63elderly patients,aged at(64±9)years old,mostly male(75%),were included,27patients(43%)with the diagnosis of CCMand29patients(46%)with the diagnosis of QTc interval prolongation;compared with patients with normal QTc interval,patients with QTc interval prolongation had higher Child-Pugh score(P=0.003),MELDscore(P=0.008),serumbile acid(P=0.01),bilirubin(P=0.007)and INR(P=0.02)but a lower fibrinogen(P=0.04).MELD score was independently related to QTc length(R=0.32,R2=0.1,P=0.007);postoperative follow-up lasted for(24.7±10.3)months;Compared with patients,Kaplan-Meier survival curve showed a lower survival rate in patients with prolonged QTc interval than in patients with normal QTc interval(P=0.047,HR2.69).Conclusions The prevalence of CCMand QTc interval prolongation in elderly liver transplant recipients was43%and46%respectively;patients with QTc interval prolongation have more serious liver disease and poorer prognosis.