Vandekerckhove Kristof, Coomans Ilse, De Bruyne Elke, De Groote Katya, Panzer Joseph, De Wolf Daniel, Boone Jan, De Bruyne Ruth
1 Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium. 2 Department of Pediatric Psychology, Ghent University Belgium, Ghent, Belgium. 3 Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium. 4 Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ghent University Hospital, Ghent, Belgium.
Transplantation. 2016 Jul;100(7):1525-31. doi: 10.1097/TP.0000000000001167.
In children, after having liver transplantation (LT), it is important to assess the quality of life (QOL). Physical fitness is an important determinant of QOL, and because cardiac function can influence exercise performance, it is the purpose of the present study to assess these factors.
Children in stable follow-up for more than 6 months post-LT were invited to participate in a case control study. Patients underwent cardiopulmonary exercise testing and echocardiography to assess systolic and diastolic function, and left ventricular wall dimensions. Health-related QOL was evaluated using child- and adolescent-reported PedsQL questionnaire.
Twenty-eight of 31 included patients performed a maximal exercise test (15 boys, 11.6 ± 2.9 years, weight, 40.9 ± 13.1 kg; length, 148.6 ± 17.3 cm; body mass index, 17.6 ± 2.3). Liver transplantation patients had lower maximal oxygen consumption (VO2max/kg) (37.5 ± 9.3 mL/kg per minute vs 44.1 ± 8.8 mL/kg per minute), shorter exercise duration (9.3 ± 2.8 minutes vs 13.3 ± 3 minutes) and lower load (71 ± 14 vs 85 ± 20%). They reached the ventilatory anaerobic threshold earlier (81.4 ± 9.5 vs 88.3 ± 11.9%). Echocardiography demonstrated increased interventricular septal wall thickness (interventricular septum in diastole Z value, +0.45 ± 0.49, P < 0.001) and more diastolic dysfunction (lower E', Z value, -0.7 ± 1.02, P = 0.002, higher E/E' Z value, 0.64 ± 1.05. P = 0.005) but no relations with cardiopulmonary exercise testing. Health-related QOL showed lower overall, emotional, psychosocial, and school functioning scores. Children on antihypertensive medication had impaired physical functioning compared with other LT patients.
Lower physical fitness level, more deconditioning and lower health-related QOL in children after LT emphasize the importance of exercise stimulation and fitness programs. Patients on antihypertensive medication seem to be the most vulnerable group suffering from decreased physical fitness.
对于儿童肝移植（LT）后患者，评估其生活质量（QOL）很重要。身体健康是生活质量的一个重要决定因素，由于心脏功能会影响运动表现，因此本研究旨在评估这些因素。
邀请肝移植术后稳定随访超过6个月的儿童参加一项病例对照研究。患者接受心肺运动试验和超声心动图检查，以评估收缩和舒张功能以及左心室壁尺寸。使用儿童和青少年报告的儿童生活质量量表（PedsQL）问卷评估与健康相关的生活质量。
31例纳入患者中有28例进行了最大运动试验（15名男孩，年龄11.6±2.9岁，体重40.9±13.1kg；身高148.6±17.3cm；体重指数17.6±2.3）。肝移植患者的最大耗氧量（VO2max/kg）较低（每分钟37.5±9.3ml/kg对44.1±8.8ml/kg），运动持续时间较短（9.3±2.8分钟对13.3±3分钟），负荷较低（71±14对85±20%）。他们更早达到通气无氧阈（81.4±9.5对88.3±11.9%）。超声心动图显示室间隔厚度增加（舒张末期室间隔Z值，+0.45±0.49，P<0.001），舒张功能障碍更明显（E'值较低，Z值，-0.7±1.02，P = 0.002，E/E'Z值较高，0.64±1.05，P = 0.005），但与心肺运动试验无关。与健康相关的生活质量在总体、情感、心理社会和学校功能方面得分较低。服用抗高血压药物的儿童与其他肝移植患者相比，身体功能受损。
肝移植术后儿童的身体素质水平较低、身体机能更差且与健康相关的生活质量较低，这凸显了运动刺激和健身计划的重要性。服用抗高血压药物的患者似乎是身体素质下降最脆弱的群体。
