Dengler Thomas J, Gleissner Christian A, Klingenberg Roland, Sack Falk-Udo, Schnabel Philipp A, Katus Hugo A
University of Heidelberg, Heidelberg, Germany.
Heart Fail Clin. 2007 Jan;3(1):69-81. doi: 10.1016/j.hfc.2007.02.010.
Patient monitoring following heart transplantation aims to detect complications (eg, acute graft rejection, vasculopathy, infection) early and contributes to risk prognostication. Numerous biomarkers of different biologic pathways have been evaluated as ancillary diagnostic and prognostic tools to reduce the need for invasive and expensive technical investigations. With the possible exception of cardiac troponins and N-type natriuretic peptides, no biomarkers have become established firmly in posttransplant patient surveillance. This article aims to show that the identification of a single biomarker that meets all needs (noninvasive diagnosis of rejection, prediction of transplant vasculopathy, survival prognostication) is unlikely. Rather, multiple marker strategies, including gene-based tests, are likely to enhance future monitoring quality and enable individualized risk-adapted patient management.
心脏移植后的患者监测旨在早期发现并发症（如急性移植物排斥反应、血管病变、感染），并有助于风险预测。不同生物学途径的众多生物标志物已被评估为辅助诊断和预后工具，以减少对侵入性和昂贵技术检查的需求。除了心肌肌钙蛋白和N型利钠肽外，没有生物标志物在移植后患者监测中得到牢固确立。本文旨在表明，找到一种满足所有需求（排斥反应的非侵入性诊断、移植血管病变的预测、生存预后）的单一生物标志物不太可能。相反，包括基于基因的检测在内的多种标志物策略可能会提高未来的监测质量，并实现个性化的风险适应性患者管理。
