PDF(Pubmed)
Abstract：
Metabolic Syndrome (MetS), a multifactorial condition that increases the risk of cardio-vascular events, is frequent in Heart-transplant (HTx) candidates and worsens with immunosuppressive therapy. The aim of the study was to analyze the impact of MetS on long-term outcome of HTx patients. Since 2007, 349 HTx patients were enrolled. MetS was diagnosed if patients met revised NCEP-ATP III criteria before HTx, at 1, 5 and 10 years of follow-up. MetS was present in 35% of patients pre-HTx and 47% at 1 year follow-up. Five-year survival in patients with both pre-HTx (65% vs. 78%, p < 0.01) and 1 year follow-up MetS (78% vs 89%, p < 0.01) was worst. At the univariate analysis, risk factors for mortality were pre-HTx MetS (HR 1.86, p < 0.01), hypertension (HR 2.46, p < 0.01), hypertriglyceridemia (HR 1.50, p=0.03), chronic renal failure (HR 2.95, p < 0.01), MetS and diabetes at 1 year follow-up (HR 2.00, p < 0.01; HR 2.02, p < 0.01, respectively). MetS at 1 year follow-up determined a higher risk to develop Coronary allograft vasculopathy at 5 and 10 year follow-up (25% vs 14% and 44% vs 25%, p < 0.01). MetS is an important risk factor for both mortality and morbidity post-HTx, suggesting the need for a strict monitoring of metabolic disorders with a careful nutritional follow-up in HTx patients.
摘要：
代谢综合征（MetS），增加心血管事件风险的多因素条件，在心脏移植（HTx）候选人中经常发生，并且在免疫抑制疗法中恶化。该研究的目的是分析MetS对HTx患者长期预后的影响。自2007年以来，纳入了349例HTx患者。如果患者在HTx之前符合修订的NCEP-ATPIII标准，则诊断为MetS，在1年，5年和10年的随访。MetS在HTx前的患者中有35％存在，在1年随访时的患者中有47％存在。两种HTx前患者的五年生存率（65%与78%,p<0.01）和1年随访MetS（78%vs89%，p<0.01)是最差的。在单变量分析中，死亡的危险因素是HTx之前的MetS（HR1.86，p<0.01），高血压（HR2.46，p<0.01），高甘油三酯血症（HR1.50，p=0.03），慢性肾功能衰竭（HR2.95，p<0.01），1年随访时MetS与糖尿病（分别为HR2.00，p<0.01；HR2.02，p<0.01）。在1年随访时，MetS确定在5年和10年随访时发生冠状动脉移植血管病变的风险更高（25％vs14％和44％vs25％，p<0.01)。MetS是HTx后死亡率和发病率的重要危险因素，提示需要对HTx患者进行严格的营养随访，并对代谢紊乱进行严格的监测。
