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肾移植受者与慢性肾脏病患者经超声心动图评估的心脏结构差异。

Differences in cardiac structure assessed by echocardiography between renal transplant recipients and chronic kidney disease patients.

作者信息

Dounousi E, Mitsis M, Naka K K, Pappas C, Lakkas L, Harisis C, Pappas K, Koutlas V, Tzalavra I, Spanos G, Michalis L K, Siamopoulos K C

机构信息

Renal Transplant Unit, University Hospital of Ioannina, Ioannina, Greece.

Cardiology Department, University Hospital of Ioannina, Ioannina, Greece.

出版信息

Transplant Proc. 2014 Nov;46(9):3194-8. doi: 10.1016/j.transproceed.2014.10.034.

DOI:10.1016/j.transproceed.2014.10.034

PMID:25420857

Abstract

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death in predialysis chronic kidney disease (CKD) and dialysis patients as well as in renal transplant recipients (RTRs). Left ventricular hypertrophy (LVH) starts early during the course of CKD and is a strong predictor of CVD in this population. Regression of LVH after a successful renal transplantation remains a debatable issue among investigators, whereas there is little data comparing echocardiographic measurements between patients with predialysis CKD and RTRs.

AIM

The aim of this study was to compare echocardiographic measurements of LV structure and function between predialysis CKD patients and RTRs of similar renal function level.

PATIENTS AND METHODS

We conducted a case control study with individual (1:2) matching from the Renal Transplant and the predialysis CKD Outpatient Clinic. For each of the 36 RTRs, two matched for gender, age and estimated glomerular filtration rate (eGFR) predialysis CKD outpatients (72 patients) were included. All patients underwent transthoracic echocardiography and LV mass, LV mass index [LVM and LVMI = LVM/BSA g/m(2)] and indices of systolic function were measured. In a subgroup of 12 RTRs we retrospectively assessed and compared the LVMI measurements at three different time points, during predialysis, dialysis and post transplant period.

RESULTS

The prevalence of LVH was 33% in RTRs and 52% in CKD patients (ns). RTRs had significantly lower LVM and LVMI levels compared with predialysis CKD patients (P = .006 and P = .008) while the other echocardiographic indices did not differ. In the subgroup of 12 RTRs, post-transplant LVMI levels (105 ± 25 g/m(2)) were significantly lower in comparison with predialysis (147 ± 57 g/m(2)) and dialysis LVMI levels (169 ± 72 g/m(2)) (P = .01, P = .01, respectively).

CONCLUSION

RTRs had significantly lower LVMI compared with predialysis CKD patients of similar age, renal function, hemoglobin and blood pressure level.

摘要

背景

心血管疾病（CVD）是透析前慢性肾脏病（CKD）患者、透析患者以及肾移植受者（RTR）的主要死因。左心室肥厚（LVH）在CKD病程早期就已出现，并且是该人群发生CVD的有力预测指标。肾移植成功后LVH的消退在研究者中仍是一个有争议的问题，而关于比较透析前CKD患者和RTR的超声心动图测量数据却很少。

目的

本研究的目的是比较透析前CKD患者与肾功能水平相似的RTR之间左心室结构和功能的超声心动图测量结果。

患者与方法

我们进行了一项病例对照研究，从肾移植门诊和透析前CKD门诊进行个体（1:2）匹配。对于36名RTR中的每一位，纳入两名在性别、年龄和估计肾小球滤过率（eGFR）方面与之匹配的透析前CKD门诊患者（共72名患者）。所有患者均接受经胸超声心动图检查，并测量左心室质量、左心室质量指数[LVM和LVMI = LVM/体表面积g/m²]以及收缩功能指标。在12名RTR的亚组中，我们回顾性评估并比较了透析前、透析期间和移植后三个不同时间点的LVMI测量值。

结果

RTR中LVH的患病率为33%，CKD患者中为52%（无显著性差异）。与透析前CKD患者相比，RTR的LVM和LVMI水平显著更低（P = 0.006和P = 0.008），而其他超声心动图指标无差异。在12名RTR的亚组中，移植后LVMI水平（105±25 g/m²）与透析前（147±57 g/m²）和透析时LVMI水平（169±72 g/m²）相比显著更低（分别为P = 0.01，P = 0.01）。