目的: 探讨肾移植受者动静脉内瘘（arteriovenous fistula,AVF）闭合后对心脏结构与功能的影响及心脏生物标志物的变化。方法: 回顾性分析2021年6月—2024年4月在新疆四七四医院肾病科接受肾移植手术的126例患者的临床资料,其中AVF闭合组66例,AVF保留组60例。所有患者均接受基线及随访心脏彩超（ultrasonic cardiogram,UCG）评估心脏结构与功能,同时检测肾脏生物标志物血清肌酐（serum creatinine,SCr）、估算肾小球滤过率（glomerular filtration rate,eGFR）、尿素氮（blood urea nitrogen,BUN）和心脏生物标志物 N末端B型利钠肽前体（N-terminal pro-B-type natriuretic peptide,NT-proBNP）、肌钙蛋白T（cardiac troponin T,cTnT）及肌钙蛋白I（cardiac troponin I,cTnI）,通过Pearson相关性和多元线性回归分析AVF闭合后NT-proBNP、cTnT、cTnI与心脏结构与功能的相关性。结果: 心脏结构方面,AVF闭合组患者的LV质量、LV质量指数、LV舒张末期容积、LV收缩末期容积、LA容积、LA容积指数、及RA面积下降（P<0.05）;心脏功能方面,AVF闭合组患者的LV心输出量、LV心脏指数及肺动脉流速降低（P<0.05）,LV射血分数和血压无明显变化（P>0.05）;生物标志物方面,AVF闭合组患者的心脏生物标志物（NT-proBNP、cTnT、cTnI）水平降低（P<0.05）,肾脏生物标志物（SCr、eGFR、BUN）无明显变化（P>0.05）;Pearson相关性分析显示,NT-proBNP、cTnT和cTnI表达与心脏结构与功能指标变化呈正相关（P<0.05）;多元线性回归显示NT-proBNP是心脏结构与功能指标变化的独立相关因素。结论: 肾移植受者AVF闭合引起的NT-proBNP 水平下降与心脏结构和功能改善密切相关,提示其在术后心脏状态评估中具有潜在价值。
Abstract
Objective To investigate the effects of arteriovenous fistula (AVF) closure on cardiac structure and function, as well as changes in cardiac biomarkers, in renal transplant recipients. Methods A retrospective analysis of clinical data from 126 patients who underwent renal transplantation at the Nephrology Department of Xinjiang 474 Hospital between June 2021 and April 2024. The study included 66 patients in the AVF closure group and 60 patients in the AVF preservation group. All patients underwent baseline and follow-up ultrasonic cardiogram (UCG) imaging to assess cardiac structure and function. Serum creatinine (SCr), estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), and cardiac biomarkers N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), and cardiac troponin I (cTnI) were measured. Pearson correlation and multiple linear regression analyses were performed to evaluate the associations between NT-proBNP, cTnT, cTnI, and cardiac structure and function post-AVF closure. Results Post-follow-up, in terms of cardiac structure, patients in the AVF closure group exhibited significant reductions in left ventricular (LV) mass, LV mass index, LV end-diastolic volume, LV end-systolic volume, left atrial (LA) volume, LA volume index, and right atrial (RA) area (P<0.05). For cardiac function, LV cardiac output, LV cardiac index, and pulmonary artery flow velocity were significantly reduced (P<0.05), while LV ejection fraction and blood pressure showed no significant changes (P>0.05). Cardiac biomarkers (NT-proBNP, cTnT, cTnI) were significantly reduced (P<0.05), whereas renal biomarkers (SCr, eGFR, BUN) showed no significant changes (P>0.05). Pearson correlation analysis revealed positive correlations between NT-proBNP, cTnT, cTnI, and changes in cardiac structure and function (P<0.05). Multiple linear regression showed that NT-proBNP was an independent correlate of changes in cardiac structure and function. Conclusion The reduction in NT-proBNP levels following AVF closure in renal transplant recipients is closely associated with improvements in cardiac structure and function, suggesting its potential value in the assessment of postoperative cardiac status.
关键词
动静脉内瘘 /
肾移植 /
NT-proBNP /
心脏结构 /
心脏功能
Key words
arteriovenous fistula /
renal transplant /
NT-proBNP /
cardiac structure /
cardiac function
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基金
乌鲁木齐市卫生健康委员会科技计划项目“肾移植受者动静脉内瘘闭合对心脏结构和功能的影响”（202362）
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