移植前改良版终末期肝病模型评分对心脏移植术后患者的预后影响分析

nalysis of the effect of pre-transplantation modified model for end-stage liver disease score on the prognosis of patients after heart transplantation

目的探索改良版终末期肝病模型(MELD-XI)评分对心脏移植术后患者预后的影响。方法回顾性分析2018年5月至2023年7月在河南省郑州市第七人民医院接受单器官心脏移植的192例受者的临床资料。将所有心脏移植受者术后5年内的生存状态作为状态变量,术前MELD-XI评分作为检验变量,应用X-tile软件分析获得术前MELD-XI评分预测心脏移植受者术后生存情况的最佳诊断节点,根据最佳诊断节点,将受者分为2组,比较2组一般临床资料。Kaplan-Meier生存分析比较2组术后5年的总体生存率。比较2组围手术期情况和远期预后,探索MELD-XI评分下各临床指标与术后死亡风险的关系。结果X-tile分析显示,术前MELD-XI评分预测心脏移植患者术后生存最佳诊断节点为8.3分,根据术前MELD-XI评分的最佳诊断节点,将患者分为MELD-XI评分>8.3分组(46例)和MELD-XI评分≤8.3分组(146例)。Kaplan-Meier生存分析显示,MELD-XI评分>8.3分组心脏移植受者术后1、3、5年总生存率明显低于MEID-XI评分≤8.3分组(P<0.001)。Logistic回归分析显示,术前体外膜氧合、供体年龄、术后呼吸机使用时间与心脏移植患者术后死亡风险存在显著相关性(均P<0.05)。Cox回归结果表明,术后呼吸机使用时间(风险比=1.001,95%置信区间:1.001~1.001,P<0.001)是心脏移植受者死亡的高危因素;术前血红蛋白(风险比=0.970,95%置信区间:0.955~0.985,P<0.001)是心脏移植受者死亡的保护性因素。结论术前MELD-XI评分能为评估心脏移植受者术后死亡风险和远期总体生存率提供参考。

Objective To investigate the effect of the modified model for end-stage liver disease(MELD-XI)score on the prognosis of patients after heart transplantation.Methods The clinical data of 192 recipients who underwent single-organ heart transplantation in the 7th People′s Hospital of Zhengzhou,Henan Province from May 2018 to July 2023 were retrospectively analyzed.The survival status of all heart transplant recipients within 5 years after operation was used as the state variable,and the preoperative MELD-XI score was used as the test variable.The X-tile software was used to determine the optimal threshold of preoperative MELD-XI score for predicting the postoperative survival of heart transplant recipients.According to the optimal threshold,the recipients were divided into two groups.Kaplan-Meier survival analysis was used to compare the 5-year overall survival rates between the two groups.The perioperative conditions and long-term prognosis of the two groups were compared,and the relationship between clinical indicators under MELD-XI score and the risk of postoperative death was explored.Results X-tile analysis showed that the best diagnostic point of preoperative MELD-XI score in predicting postoperative survival of heart transplantation patients was 8.3.According to the best diagnostic point of preoperative MELD-XI score,the patients were divided into MELD-XI score>8.3 group(46 cases)and MELD-XI score≤8.3 group(146 cases).Kaplan-Meier survival analysis showed that the overall survival rates of heart transplant recipients in the MELD-XI score>8.3 group were significantly lower than those in the MEID-XI score≤8.3 group at 1,3,and 5 years postoperatively(P<0.001).Logistic regression analysis showed that preoperative extracorporeal membrane oxygenation,donor age,and postoperative ventilator use time were significantly correlated with the risk of death after heart transplantation(all P<0.05).Cox regression analysis showed that postoperative ventilator use time(hazard rate=1.001,95%confidence interval:1.001-1.001,P<0.001)was a high risk factor for death of heart transplant recipients.Preoperative hemoglobin(hazard rate=0.970,95%confidence interval:0.955-0.985,P<0.001)was a protective factor for death in heart transplant recipients.Conclusion Preoperative MELD-XI score can be used to evaluate the risk of postoperative mortality and long-term overall survival in heart transplant recipients.