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供者年龄对特发性肺纤维化患者肺移植术后短期生存结局的影响

王净, 胡春兰, 于慧智, 等. 供者年龄对特发性肺纤维化患者肺移植术后短期生存结局的影响[J]. 器官移植, 2023, 14(3): 420-426. doi: 10.3969/j.issn.1674-7445.2023.03.014
引用本文: 王净, 胡春兰, 于慧智, 等. 供者年龄对特发性肺纤维化患者肺移植术后短期生存结局的影响[J]. 器官移植, 2023, 14(3): 420-426. doi: 10.3969/j.issn.1674-7445.2023.03.014
Wang Jing, Hu Chunlan, Yu Huizhi, et al. Effect of donor age on short-term survival of patients with idiopathic pulmonary fibrosis after lung transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(3): 420-426. doi: 10.3969/j.issn.1674-7445.2023.03.014
Citation: Wang Jing, Hu Chunlan, Yu Huizhi, et al. Effect of donor age on short-term survival of patients with idiopathic pulmonary fibrosis after lung transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(3): 420-426. doi: 10.3969/j.issn.1674-7445.2023.03.014

供者年龄对特发性肺纤维化患者肺移植术后短期生存结局的影响

doi: 10.3969/j.issn.1674-7445.2023.03.014
基金项目: 

国家自然科学基金 8207011015

江苏省科技计划重点研发项目 BE2022697

无锡市太湖人才计划国际国内顶尖医学专家团队 2019-THRCTD-1

详细信息
    作者简介:
    通讯作者:

    胡春晓(ORCID:0000-0002-4825-0645),主任医师,研究方向为肺缺血-再灌注损伤、重要器官功能保护、ECMO辅助下肺移植围手术期的应用管理及脑损伤的机制,Email:huchunxiao91211@163.com

  • 中图分类号: R617, R563

Effect of donor age on short-term survival of patients with idiopathic pulmonary fibrosis after lung transplantation

More Information
  • 摘要:   目的  探讨供者年龄对特发性肺纤维化(IPF)患者肺移植术后短期生存结局的影响。  方法  回顾性分析235例IPF肺移植供、受者的临床资料。使用单因素和多因素Cox比例风险回归模型分析供者年龄与IPF患者肺移植术后短期死亡风险的关系,采用Kaplan-Meier法绘制生存曲线。  结果  单因素Cox回归分析结果显示,供者年龄与IPF患者肺移植术后1年病死率相关,供者年龄每增加1岁,受者术后1年死亡风险增加0.020倍(P=0.009)。供者氧合指数,受者术前氧合指数、术前肺源分配评分、术前氨基末端脑钠肽前体、移植方式、术中体外膜氧合方式和术中输血量与肺移植术后1年病死率存在相关性(均为P < 0.1)。多因素Cox回归分析显示,供者年龄与IPF患者肺移植术后30、90、180 d和1年的死亡风险无相关性(均为P > 0.05)。敏感性分析发现供者年龄 < 18岁、18~33岁、34~49岁、≥50岁的肺移植受者术后30、90、180 d和1年死亡风险差异均无统计学意义(均为P > 0.05)。  结论  本研究未观察到供者年龄对IPF患者肺移植术后短期生存存在影响,综合考虑供者机械通气时间、氧合指数、感染等因素后,可考虑扩大肺移植供者年龄范围。

     

  • 图  1  各组受者术后早期的生存曲线

    Figure  1.  Early postoperative survival curves of recipients in each group

    图  2  各组受者术后早期死亡风险的多因素Cox回归分析

    Figure  2.  Multivariate Cox regression analysis of risk of early postoperative death of recipients in each group

    表  1  IPF患者肺移植术后1年病死率的单因素Cox回归分析

    Table  1.   Univariate Cox regression analysis of 1 year fatality after lung transplantation in patients with IPF

    变量 基本特征(n=235) β HR(95% CI P
    供者资料
     性别[n(%)]
      女 55(23.4) 0.002 1.002(0.634~1.578) 0.995
      男 180(76.6) 参照值 1.000
     年龄[M(P25P75),岁] 40(29, 48) 0.020 1.020(1.005~1.036) 0.009
     BMI[M(P25P75),kg/m2] 23(22, 25) 0.024 1.024(0.961~1.091) 0.461
     机械通气时间[M(P25P75),d] 5(3, 8) -0.002 0.998(0.986~1.010) 0.741
     氧合指数[M(P25P75),mmHg] 440(370, 498) -0.002 0.998(0.995~1.000) 0.054
     冷缺血时间[M(P25P75),min] 453(375, 545) 0 1.000(0.999~1.002) 0.772
    受者资料
     性别[n(%)]
      女 39(16.6) -0.066 0.936(0.564~1.554) 0.799
      男 196(83.4) 参照值 1.000
     年龄[M(P25P75),岁] 61(54, 66) 0.003 1.003(0.985~1.021) 0.737
     BMI[M(P25P75),kg/m2] 22(20, 25) 0.017 1.017(0.970~1.067) 0.475
     术前糖尿病史[n(%)]
      否 175(74.5) 0.088 1.092(0.698~1.709) 0.700
      是 60(25.5) 参照值 1.000
     术前高血压病史[n(%)]
      否 175(74.5) 0.329 1.309(0.870~2.221) 0.169
      是 60(25.5) 参照值 1.000
     术前氧合指数[M(P25P75),mmHg] 267(219, 310) -0.003 0.997(0.994~0.999) 0.010
     术前LAS[M(P25P75),分] 40(36, 53) 0.014 1.014(1.003~1.025) 0.010
     术前血清肌酐[M(P25P75),μmol/L] 58(50, 71) -0.007 0.993(0.980~1.005) 0.254
     术前eGFR[M(P25P75),mL/min] 104(83, 126) 0.002 1.002(0.996~1.009) 0.437
     术前肺动脉收缩压[M(P25P75),mmHg] 41(28, 60) -0.006 1.006(0.996~1.016) 0.215
     术前肺动脉平均压[M(P25P75),mmHg] 31(25, 39) 0.007 1.007(0.989~1.026) 0.443
     术前NT-proBNP[M(P25P75),pg/mL] 129(53, 350) 0 1.000(1.000~1.000) 0.061
    手术资料
     移植方式[n(%)]
      单肺移植 125(53.3) -0.378 0.685(0.465~1.010) 0.056
      双肺移植 110(46.7) 参照值 1.000
     术中ECMO方式[n(%)]
      静脉-静脉 131(55.8) 0.527 1.694(0.934~3.074) 0.083
      静脉-动脉 65(27.5) 0.354 1.425(0.738~2.752) 0.291
      未使用 39(16.7) 参照值 1.000
     手术时间[M(P25P75),min] 320(240, 400) 0.001 1.001(0.999~1.003) 0.312
     术中出血量[M(P25P75),mL] 1 000(600, 1 200) 0 1.000(1.000~1.000) 0.988
     术中输血量[M(P25P75),mL] 1 025(600, 1 450) 0 1.000(1.000~1.000) 0.002
     术中尿量[M(P25P75),mL/(kg·h)] 5(4, 7) -0.033 0.967(0.909~1.029) 0.293
    注:①1 mmHg=0.133 kPa。
    下载: 导出CSV

    表  2  供者年龄与IPF患者肺移植术后死亡风险的多因素Cox回归分析

    Table  2.   Multivariate Cox regression analysis of donor age and risk of death after lung transplantation in patients with IPF

    随访时间(d) β HR 95% CI P
    365 0.013 1.013 0.991~1.036 0.237
    180 0.020 1.020 0.995~1.046 0.117
    90 0.017 1.017 0.991~1.044 0.200
    30 0.024 1.024 0.988~1.062 0.190
    下载: 导出CSV
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  • 收稿日期:  2023-01-22
  • 刊出日期:  2023-05-15

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