肝移植受者术后长期心血管风险因素的改变和心血管表型的演变

IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Kardiologiya Pub Date : 2024-01-31 DOI:10.18087/cardio.2024.1.n2612
E A Grigorenko, K Yu Antyukh, O O Rummo, N P Mitkovskaya
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引用次数: 0

摘要

目的:评估肝移植受者术后长期慢性缺血性心脏病(CIHD)发生的传统和额外心血管风险因素(CVRFs)的作用:进行了一项单中心前瞻性队列研究。研究纳入了 740 名慢性终末期肝病(CESLD)和肝硬化性心肌病(CCMP)患者。在观察期间(5.4±2.29 年),患者被分为两组:肝移植受者(420 人)和等待名单中未接受器官捐献的 CESLD 患者(320 人)。研究人员对列入候选名单的患者进行了CVRFs、病史、临床、实验室和仪器数据的研究,这些数据涵盖了肝-心连续过程的所有阶段:在术后长期观察期间,肝移植受者属于心血管高危人群:在5年的观察期内,35.7%的受者(n=150)出现了代谢综合征(MS),9.8%的受者出现了与MS相关的经证实的CIHD。传统的 CVRF 发生率很高(动脉高血压 88.6%;肥胖 36.6%;高胆固醇血症 77.8%;高甘油三酯血症 43.6%;高密度脂蛋白胆固醇浓度降低 35.4%;低密度脂蛋白胆固醇浓度升高 66.8%,极低密度脂蛋白胆固醇升高 51.2%;致动脉粥样硬化指数升高 61.5%)。在术后长期观察期间,与患者在候诊期间相比,出现了更多的 CVRFs:体重指数、钙指数、一氧化氮代谢物、内皮素-1、同型半胱氨酸、细胞间粘附分子 VCAM-1 和 ICAM-1,以及内皮依赖性血管舒张和肾小球滤过率下降至低于 60 ml/min/1.73 m2。我们创建了一个 CIHD 发病模型。该模型使用了一系列独立的风险因素,预测准确率达 84.6%:研究结果表明,CVRFs发生了改变,肝移植受者的心血管表型也发生了动态变化:CCMP在候选名单中不断发展,CCMP表现在正位肝移植后的前12个月中逐渐消失,而在术后长期,总的心血管风险和CIHD的可能性都在增加。
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Modification of Cardiovascular Risk Factors and the Evolution of The Cardiovascular Phenotype of Liver Transplant Recipients in the Long -Term Postoperative Period.

Aim: To evaluate the contribution of traditional and additional cardiovascular risk factors (CVRFs) to the development of chronic ischemic heart disease (CIHD) in liver transplant recipients during the long-term postoperative period.

Material and methods: A single-center prospective cohort study was conducted. The study included 740 patients with chronic end-stage liver disease (CESLD) and cirrhotic cardiomyopathy (CCMP). During the observation period (5.4±2.29 years), patients were divided into two groups: liver transplant recipients (n=420) and patients with CESLD on the waiting list who did not receive a donor organ (n=320). In patients enrolled to the study upon inclusion in the waiting list, CVRFs, history, clinical and laboratory and instrumental data were studied at all stages of the hepato-cardiac continuum.

Results: During the long-term postoperative period, liver transplant recipients belonged to the group of high cardiovascular risk: over a 5-year observation period, 35.7% (n=150) of them developed metabolic syndrome (MS), 9.8% developed verified CIHD associated with MS. The incidence of traditional CVRFs was high (arterial hypertension, 88.6%; obesity, 36.6%; hypercholesterolemia, 77.8%; hypertriglyceridemia, 43.6%; reduced concentration of high-density lipoprotein cholesterol, 35.4%; increased concentrations of low-density lipoprotein cholesterol, 66.8% and very low-density lipoprotein cholesterol, 51.2%; increased atherogenic index, 61.5%). During the long-term postoperative period as compared to the period when patients were on the waiting list, additional CVRFs appeared: increases in body mass index, calcium index, nitric oxide metabolites, endothelin-1, homocysteine, intercellular adhesion molecules VCAM-1 and ICAM-1, and decreases in endothelium-dependent vasodilation and glomerular filtration rate to less than 60 ml/min/1.73 m2. A model for the development of CIHD was created. The model uses a complex of independent risk factors and demonstrates a predictive accuracy of 84.6%.

Conclusion: The study results indicate a modification of CVRFs and a dynamic change in the cardiovascular phenotype of liver transplant recipients: progression of CCMP during their stay on the waiting list, regression of CCMP manifestations during the first 12 months after orthotopic liver transplantation, and increases in the total cardiovascular risk and likelihood of CIHD in the long-term postoperative period.

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来源期刊
Kardiologiya
Kardiologiya 医学-心血管系统
CiteScore
1.70
自引率
20.00%
发文量
94
审稿时长
3-8 weeks
期刊介绍: “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.
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