雌激素、免疫功能与衰老对心脏移植结局的影响。
The role of estrogen, immune function and aging in heart transplant outcomes.
机构信息
General Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
Heart Failure and Transplantation Cardiology, Providence Sacred Heart Medical Center & Children's Hospital, Spokane, WA, USA.
出版信息
Am J Surg. 2019 Oct;218(4):737-743. doi: 10.1016/j.amjsurg.2019.07.007. Epub 2019 Jul 17.
BACKGROUND
Aging and loss of estrogen suppress immune function, potentially improving survival after orthotopic heart transplant (OHT). The effect of female aging on OHT outcomes is unknown.
METHODS
Between 1995 and 2015, 41,299 adult OHT recipients (24.3% women) were studied using a retrospective multi-institutional cohort. Patients were stratified by age and gender into premenopausal (18-39 years), perimenopausal (40-49 years), and postmenopausal (≥50 years) groups. Kaplan-Meier survival analyses and risk-adjusted models examined gender differences across groups at one, five, and ten years.
RESULTS
Kaplan-Meier survival was equivalent for postmenopausal women and men, and lower for premenopausal women than men at all time points (p ≤ 0.05). Postmenopausal women had higher risk-adjusted five-year survival than premenopausal women (AOR 1.61, 95% CI 1.15-2.25, p = 0.006).
CONCLUSIONS
Premenopausal women have lower unadjusted survival than men after OHT. Post-menopausal women have significantly better five-year survival than pre-menopausal women. Menopause may contribute to improved survival after OHT.
背景
衰老和雌激素的丧失会抑制免疫功能，这可能会提高原位心脏移植（OHT）后的存活率。女性衰老对 OHT 结果的影响尚不清楚。
方法
在 1995 年至 2015 年间，使用回顾性多机构队列研究了 41299 名成年 OHT 受者（24.3%为女性）。根据年龄和性别将患者分为绝经前（18-39 岁）、围绝经期（40-49 岁）和绝经后（≥50 岁）组。使用 Kaplan-Meier 生存分析和风险调整模型在一年、五年和十年时检查了不同性别在各分组中的差异。
结果
Kaplan-Meier 生存分析显示，绝经后女性与男性的生存情况相当，而绝经前女性的生存情况比男性差，在所有时间点均如此（p≤0.05）。与绝经前女性相比，绝经后女性的风险调整五年生存率更高（AOR 1.61，95%CI 1.15-2.25，p=0.006）。
结论
绝经前女性在接受 OHT 后未调整的生存率低于男性。绝经后女性的五年生存率明显高于绝经前女性。绝经可能是 OHT 后生存率提高的原因之一。
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