Madershahian Navid, Wittwer Thorsten, Strauch Justus, Wippermann Jens, Rahmanian Parwis, Franke Ulrich F W, Wahlers Thorsten
Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany.
J Card Surg. 2008 Sep-Oct;23(5):468-73. doi: 10.1111/j.1540-8191.2008.00625.x.
It was the aim of the study to determine the kinetics of procalcitonin (PCT) levels following heart transplantation (HTx) and to investigate the prognostic suitability of postoperative changes in PCT levels for patients' outcome.
52 adult heart transplant recipients were divided into two groups according to their in-hospital postoperative outcome retrospectively. Group A (eventful +/- nonsurvivors) of 24 patients (21 males, three females, mean age 54.5 +/- 10.1 years) was compared with Group B (uneventful) of 28 patients (22 males, six females, mean age 53.6 +/- 8.1 years).
Serum PCT levels were measured before and daily after operation until day seven. Demographic data, operative data, and clinical endpoints (mortality, infection, severe complication) were analyzed. Mean PCT levels immediately before HTx were <0.3 ng/mL in both groups, respectively. PCT increased with maximum concentrations on the second post-operative day (Group A: 54.6 +/- 44.3 ng/mL; Group B: 9.1 +/- 9.3 ng/mL). After day two the levels decreased to 7.8 +/- 8.8 ng/mL in Group A and 0.6 +/- 0.8 ng/mL in Group B on day seven. Postoperative PCT was increased in nonsurvivors compared to survivors in Group A (81.6 +/- 58.7 ng/mL vs 44.7 +/- 19.8 ng/ml; p < 0.05).
PCT levels have been consistently low (<10 ng/mL) in patients with an uneventful course, but more frequently increased in patients with postoperative complications and even associated with an increased mortality early postoperatively when values exceed 80 ng/mL. As a clinical consequence, PCT levels in the first few days following cardiac transplantation can help to identify patients at risk, when concentrations exceed the "normal" posttransplant range.
本研究旨在确定心脏移植（HTx）后降钙素原（PCT）水平的变化动力学，并探讨术后PCT水平变化对患者预后的预测适用性。
回顾性地根据52例成年心脏移植受者的术后院内结局将其分为两组。将24例患者（21例男性，3例女性，平均年龄54.5±10.1岁）的A组（病情复杂伴/不伴死亡者）与28例患者（22例男性，6例女性，平均年龄53.6±8.1岁）的B组（病情平稳者）进行比较。
术前及术后每日直至第7天测量血清PCT水平。分析人口统计学数据、手术数据及临床终点（死亡率、感染、严重并发症）。两组在心脏移植术前即刻的平均PCT水平均<0.3 ng/mL。PCT在术后第2天达到最高浓度（A组：54.6±44.3 ng/mL；B组：9.1±9.3 ng/mL）。术后第2天之后，A组的水平在第7天降至7.8±8.8 ng/mL，B组降至0.6±0.8 ng/mL。在A组中，非存活者的术后PCT水平高于存活者（81.6±58.7 ng/mL对44.7±19.8 ng/ml；p<0.05）。
病情平稳的患者PCT水平一直较低（<10 ng/mL），但术后有并发症的患者中PCT水平升高更为常见，当值超过80 ng/mL时甚至与术后早期死亡率增加相关。因此，心脏移植后的头几天，当PCT浓度超过“正常”移植后范围时，PCT水平有助于识别有风险的患者。
