心脏移植物血管病的临床研究进展

Clinical research progress of cardiac allograft vasculopathy

心脏移植物血管病(CAV)作为限制心脏移植术后受者存活时间的主要因素之一,其确切的发病机制仍有待探索,其中涉及多种免疫应答和非免疫因素间的相互作用所导致的血管内皮损伤和修复反应。CAV诊断金标准为冠状动脉造影术,但经颈静脉心内膜心肌活检术、血管内超声等方式也具有一定优势。CAV外科治疗方式十分有限,再次心脏移植由于供器官短缺和术后并发症发生风险较高,临床上并不推荐;经皮冠状动脉介入治疗和冠状动脉旁路移植术也只能作为局限的姑息治疗手段。因此,药物干预是目前CAV治疗的关注领域。CAV的发病机制和药物治疗仍会是未来一段时间内心脏移植的重点研究方向。

As one of the main factors limiting the survival time of patients after heart transplantation,cardiac allograft vasculopathy(CAV)and its exact pathogenesis remains to be explored,which involves vascular endothelial damage and repair response caused by a variety of immune responses and the interaction of non-immune factors.Coronary angiography is the current gold standard for the diagnosis of CAV.Furthermore,transjugular endomyocardial biopsy and intravascular ultrasound are also used to assess CAV.The surgical treatment for CAV is fairly limited.Heart retransplantation is not recommended in clinical practice because of the shortage of donor organs and high risk of complications.Percutaneous coronary intervention and coronary artery bypass grafting can only be used as restricted palliative treatment.Therefore,drug intervention is the current focus for the treatment of CAV.The pathogenesis and drug treatment of CAV will still be the key research direction of heart transplantation for some time to come.