原位心脏移植术后冠状动脉病变危险因素及诊断方法初探

摘要

目的 探讨原位心脏移植术后冠状动脉病变的可疑危险因素及诊断方法.方法 选取16例原位心脏移植术后复查患者,同期行冠状动脉造影(Gensini总积分表示)及静息心肌显像(RMPI);入选可疑危险因素包括性别、年龄、体质量指数、高血压、巨细胞病毒(CMV)感染、热缺血时间、冷缺血时间、糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、总胆固醇(TC)、环孢素A峰值及谷值、存活时间;采用描述性统计分析、Wilcoxon秩和检验、Spearman秩相关检验、Fisher精确概率法等进行统计学分析.结果 移植术后冠脉病变程度与供心热缺血时间(rs=0.693,P=0.003)及受者存活时间(rs=0.716,P=0.002)有显著正相关性,与其余可疑危险因素不具有显著相关性;RMPI结果与冠脉造影结果具有一致性(P=0.035),以RMPI结果来衡量冠状动脉狭窄程度,其灵敏度和特异度分别达到88.9%和71.4%.结论 随着术后生存时间延长,冠状动脉病变呈逐渐加重的趋势;供心的热缺血时间较长者易出现冠状动脉狭窄性病变;RMPI有可能成为心脏移植术后反映心肌供血情况的常规检查项目,对移植术后冠心病具有一定的诊断价值.%Objective To investigate the conceivable risk factors for coronary artery disease after orthotopic cardiac transplantation and search for the suitable diagnostic method. Methods 16 patients were selected to undergo coronary angiography (evaluated by Gensini Score) and rest myocardial perfusion imaging (RMPI) , who had received orthotopic cardiac transplantation. The possible conceivable risk factors include: sex, age, the body mass index (BMI) , high blood pressure, infection of cytomegalovirus (CMV) , cold ischemia time, glycosylated hemoglobin ( HbA1c) , low density lipoprotein cholesterol-C (LDL-C), high density lipoprotein cholesterol-C(HDL-C) , triglyceride(TC) , total cholesterol(TG) , peak value and valley value of cyclosporine A and survival time. The statistical analysis were performed by descriptive statistics, Wilcoxon rank sum test, Spearman rank correlation test, Fisher's exact probabilistic method. Results The statistics analysis showed the extent of pathological change in coronary artery after orthotopic cardiac transplantation was significantly correlated with warm ischemia time (rx = 0. 693, P = 0. 003) and survival time(rs = 0. 716,P = 0. 002) ; However, other conceivable risk factors had nothing to do with coronary angiographic lesions. The result of RMPI was consistent with coronary angiography (P = 0. 035); A sensitivity of 88. 9% and a specificity of 71. 4% for RMPI to measure the extent of pathological changes in coronary artery were achieved. Conclusions Angiographic lesions aggravate with the prolongation of survival time coronary, and donor heart with long warm ischemia time has more risk of transplant associated coronary artery disease(TxCAD). RMPI has the potential to replace coronary angiography to become a routine test to monitor TxCAD.