移植前C-反应蛋白≥20mg/L可预测心脏移植后感染相关死亡率
Pre-Transplant C-Reactive Protein ≥ 20 mg/L Predicts Infection-Related Mortality After Heart Transplantation.
摘要(中文译文)
心脏移植（HTX）术后患者需要终身接受免疫抑制治疗以防止移植物排斥反应，从而增加了感染的易感性。C反应蛋白（CRP）是公认的全身性炎症生化标志物，通常随感染严重程度增加而升高。由于心脏移植前CRP升高（≥20 mg/L）的预后意义尚不明确，我们分析了其对移植后结局的影响。我们开展了一项回顾性、观察性、单中心研究，纳入2000年至2019年间在海德堡心脏中心接受心脏移植的418例患者。根据移植前CRP水平（<20或≥20 mg/L）对心脏移植受者进行分组。我们分析了供者和受者特征、移植后药物治疗以及移植后死亡率（包括死亡原因）。418例心脏移植受者中有102例（24.4%）移植前CRP≥20 mg/L。这些患者的30天（11.8%对5.1%，=0.019）、1年（39.2%对17.4%，<0.001）、2年（42.2%对23.1%，<0.001）和5年移植后死亡率（47.1%对30.4%，=0.002）均显著更高。在移植前CRP≥20 mg/L的患者中，感染/脓毒症更常成为心脏移植后五年内的死亡原因（28.4%对15.8%，=0.005），尤其是肺部感染（19.6%对9.5%，=0.006）。多因素Cox回归分析显示，移植前CRP≥20 mg/L是移植后5年死亡率的独立预测因子（HR：1.630，95% CI：1.144-2.323，=0.007）。移植前CRP≥20 mg/L可识别出心脏移植后感染相关死亡率（尤其是肺部感染）风险增加的心脏移植候选者。建议加强移植前隐匿性感染的评估以及移植后密切的感染监测。
Abstract
: Patients after heart transplantation (HTX) require lifelong immunosuppressive therapy to prevent graft rejection, thereby increasing susceptibility to infections. C-reactive protein (CRP) is a recognized biochemical marker of system-wide inflammation and generally rises with increasing infection severity. As the prognostic relevance of elevated CRP (≥20 mg/L) prior to HTX has been unclear, we analyzed its effects on post-transplant outcomes. : We performed a retrospective, observational, single-center study including 418 patients who received HTX at Heidelberg Heart Center between the years 2000 and 2019. HTX recipients were grouped according to pre-transplant CRP (<20 or ≥20 mg/L). We analyzed donor and recipient characteristics, post-transplant pharmacotherapy, and post-transplant mortality including causes of death. : Pre-transplant CRP was ≥20 mg/L in 102 of 418 HTX recipients (24.4%). These patients had a significantly higher 30-day (11.8% versus 5.1%, = 0.019), 1-year (39.2% versus 17.4%, < 0.001), 2-year (42.2% versus 23.1%, < 0.001), and 5-year post-transplant mortality (47.1% versus 30.4%, = 0.002). Infection/sepsis was more frequently the cause of death within five years after HTX among patients with a pre-transplant CRP ≥ 20 mg/L (28.4% vs. 15.8%, = 0.005), particularly pulmonary infections (19.6% vs. 9.5%, = 0.006). Multivariate Cox regression showed pre-transplant CRP ≥ 20 mg/L as an independent predictor of 5-year post-transplant mortality (HR: 1.630, 95% CI: 1.144-2.323, = 0.007). : Pre-transplant CRP ≥ 20 mg/L identifies HTX candidates at increased risk of infection-related mortality after HTX, particularly pulmonary infections. Intensified pre-transplant evaluation for occult infection and close post-transplant infectious surveillance is advisable.
如何引用
AMA
Matthias Helmschrott, Karsten M Heil, Rasmus Rivinius, Ann-Kathrin Rahm, Philipp Ehlermann, Norbert Frey, et al. Pre-Transplant C-Reactive Protein ≥ 20 mg/L Predicts Infection-Related Mortality After Heart Transplantation.. Journal of clinical medicine. 2026; doi:10.3390/jcm15041332.
APA
Matthias Helmschrott, Karsten M Heil, Rasmus Rivinius, Ann-Kathrin Rahm, Philipp Ehlermann, Norbert Frey, et al (2026). Pre-Transplant C-Reactive Protein ≥ 20 mg/L Predicts Infection-Related Mortality After Heart Transplantation.. Journal of clinical medicine. https://doi.org/10.3390/jcm15041332
GB/T 7714
Matthias Helmschrott, Karsten M Heil, Rasmus Rivinius, Ann-Kathrin Rahm, Philipp Ehlermann, Norbert Frey, et al. Pre-Transplant C-Reactive Protein ≥ 20 mg/L Predicts Infection-Related Mortality After Heart Transplantation.[J]. Journal of clinical medicine, 2026 doi:10.3390/jcm15041332.
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