扩张型心肌病受者心脏移植前血NT-proBNP水平对术后长期存活的影响

Effect of pre-operative N-terminal-pro-brain natriuretie levels on survival after heart transplantation among dilated cardiomyopathy patients

目的对扩张型心肌病(DCM)接受心脏移植受者进行存活分析,并探讨影响受者术后长期存活的术前危险因素。方法收集2004年6月至2017年10月接受心脏移植的394例DCM受者的存活数据,回顾性分析其术前血NT-proBNP水平及国际心肺移植学会公认的影响受者存活的供受者术前危险因素,采用Kaplan-Meier生存曲线描述存活率并做出生存曲线,分析受者和供者的一般资料,并采用ROC曲线分析术前各指标对死亡预测的cutoff值,根据该截断值分层,最后采用COX回归模型分析影响心脏移植术后长期存活的危险因素并作出生存曲线,结果采用Log-rank检验分析。结果术前血NT-proBNP的cutoff值为4000ng/L,根据该截断值分成<4000ng/L(296例)组和≥4000ng/L(73例)组,COX回归显示,血NT-proBNP≥4000ng/L为DCM受者心脏移植术后的一项危险因素。两组的Kaplan-Meier生存曲线,采用Log-rank检验,差异有统计学意义(P=0.029)。其中在肺动脉收缩压(PASP)≥40mmHg的受者中,术前血NT-proBNP≥4000ng/L(58例)与<4000ng/L(190例)的受者存活率差异有统计学意义(P=0.027),而在PASP<40mmHg组中两者差异却无统计学意义(P>0.05)。结论虽然DCM受者心脏移植术后1年、3年、5年、7年及10年存活率高达97.2%、94.5%、91.9%、88.0%及83.1%,但是肺动脉高压的DCM受者术前血NT-proBNP≥4000ng/L仍是影响其心脏移植术后长期存活的危险因素,提示把握心脏移植的时机,对肺动脉高压的心脏移植受者更应注重术前危险因素的控制和供受者的体重匹配。

Objective To study the effect of possible factors pre-operativly on recipient survival after heart transplantation among the dilated cardiomyopathy (DCM) patients. Methods394 DCM recipients went through heart transplantation from June 2004 to October 2017 in our center, and the pre-operative NT-proBNP levels and risk factors influencing the post-operational survival reported by ISHLT retrospectively were analyzed. Kaplan Meier method was used to calculate the 1-10 years survival rate of the DCM patients and analyze the clinical data of the recipients and the donors, and the ROC method was applied to find the cutoff point of every pre-operation event. The recipients were divided into two groups according to the cutoff point:<4 000 ng/L group (n=296) and ≥4 000 ng/L group (n=73). COX regression curve was used to decide the hazard ratio and the Kaplan Meier curve was drawn. The result was verified by Log-rank. ResultsThe cutoff point of the pre-operative NT-proBNP level was 4000 ng/L. By analyzing the NT-proBNP levels between 2 groups, the relationship between them and the survival rate was acknowledged and the NT-proBNP level ≥4 000 ng/L was a risk factor (P=0.029, Kaplan Meier method). In the recipients whose pulmonary arterial systolic pressure (PASP) was more than 40 mmHg, the survival rate between <4 000 ng/L group (n=190) and ≥4 000 ng/L group (n=58)] showed significant difference (P=0.027), and there was no significant difference in the recipients whose PASP was less than 40 mmHg (P>0.05). ConclusionThe 1-, 3-, 5-, 7-, and 10-year survival rate in our patients was 97.2%, 94.5%, 91.9%, 88.0% and 83.1% respectively, which shows advantage over other international reports. The pre-operative NT-proBNP level ≥4 000 ng/L is a risk factor in the DCM patients who have pulmonary hypertension, so determination and dynamic monitoring of the pre-operative NT-proBNP level may be beneficial to the survival of cardiac transplantation, especially among the patients who have higher PASP level.