C-反应蛋白水平和左心室质量与心脏移植后的急性细胞排斥反应有关。
C-Reactive protein level and left ventricular mass are associated with acute cellular rejection after heart transplant.
机构信息
Programa de Transplante Cardiaco, Hospital Israelita Albert Einstein (HIAE), Sao Paulo, SP, BR.
Universidade Federal do Parana, Curitiba, PR, BR.
出版信息
Clinics (Sao Paulo). 2021 Dec 6;76:e3020. doi: 10.6061/clinics/2021/e3020. eCollection 2021.
OBJECTIVES
Acute cellular rejection (ACR) remains a major complication of heart transplant (HT). The gold standard for its diagnosis is endomyocardial biopsy (EMB), whereas the role of non-invasive biomarkers for detecting ACR is unclear. This study aimed to identify non-invasive biomarkers for the diagnosis of ACR in patients undergoing HT and presenting with normal left ventricular function.
METHODS
We evaluated patients who underwent HT at a single center between January 2010 and June 2019. Patients were enrolled after HT, and those with left ventricular (LV) systolic dysfunction before EMB were excluded. We included only the results of the first EMB performed at least 30 days after HT (median, 90 days). Troponin, B-type natriuretic peptide (BNP), and C-reactive protein (CRP) levels were measured and echocardiography was performed up to 7 days before EMB. ACR was defined as International Society for Heart and Lung Transplantation grade 2R or 3R on EMB. We performed logistic regression analysis to identify the non-invasive predictors of ACR (2R or 3R) and evaluated the accuracy of each using area under the receiver operator characteristic curve analysis.
RESULTS
We analyzed 72 patients after HT (51.31±13.63 years; 25 [34.7%] women); of them, 9 (12.5%) developed ACR. Based on multivariate logistic regression analysis, we performed forward stepwise selection (entry criteria, p<0.05). The only independent predictors that remained in the model were CRP level and LV mass index. The optimal cut-off point for CRP level was ≥15.9 mg/L (odds ratio [OR], 11.7; p=0.007) and that for LV mass index was ≥111 g/m2 (OR, 13.6; p=0.003). The area under the receiver operating characteristic curve derived from this model was 0.87 (95% confidence interval [CI], 0.75-0.99), with sensitivity of 85.7% (95% CI, 42.1%-99.6%), specificity of 78.4% (95% CI, 64.7%-88.7%), positive predictive value of 35.3% (95% CI, 14.3%-61.7%), and negative predictive value of 97.6% (95% CI, 87.1%-99.9%).
CONCLUSIONS
Among patients undergoing HT, CRP level and LV mass were directly associated with ACR, but troponin and BNP levels were not.
目的
急性细胞排斥（ACR）仍然是心脏移植（HT）的主要并发症。其诊断的金标准是心肌内膜活检（EMB），而用于检测 ACR 的非侵入性生物标志物的作用尚不清楚。本研究旨在确定接受 HT 并伴有正常左心室功能的患者中用于诊断 ACR 的非侵入性生物标志物。
方法
我们评估了 2010 年 1 月至 2019 年 6 月期间在一家单中心接受 HT 的患者。在 HT 后对患者进行了入组，并且排除了 EMB 前左心室（LV）收缩功能障碍的患者。我们仅纳入了 HT 后至少 30 天（中位数为 90 天）进行的第一次 EMB 的结果。在 EMB 前最多 7 天，测量了肌钙蛋白、B 型利钠肽（BNP）和 C 反应蛋白（CRP）水平，并进行了超声心动图检查。ACR 定义为 EMB 上的国际心肺移植协会 2R 或 3R 级。我们进行了逻辑回归分析，以确定 ACR（2R 或 3R）的非侵入性预测因子，并使用接收器工作特征曲线分析评估每个预测因子的准确性。
结果
我们分析了 72 例 HT 后患者（51.31±13.63 岁；25 [34.7%] 名女性）；其中 9 例（12.5%）发生 ACR。基于多元逻辑回归分析，我们进行了向前逐步选择（入选标准，p<0.05）。模型中唯一保留的独立预测因子是 CRP 水平和 LV 质量指数。CRP 水平的最佳截断点为≥15.9mg/L（比值比[OR]，11.7；p=0.007），LV 质量指数的最佳截断点为≥111g/m2（OR，13.6；p=0.003）。该模型得出的接收器操作特征曲线下面积为 0.87（95%置信区间[CI]，0.75-0.99），敏感性为 85.7%（95%CI，42.1%-99.6%），特异性为 78.4%（95%CI，64.7%-88.7%），阳性预测值为 35.3%（95%CI，14.3%-61.7%），阴性预测值为 97.6%（95%CI，87.1%-99.9%）。
结论
在接受 HT 的患者中，CRP 水平和 LV 质量与 ACR 直接相关，但肌钙蛋白和 BNP 水平则没有。
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