摘要
目的
探究糖尿病和(或)高血压患者行经导管主动脉瓣置换术后肾功能的改变情况,影响因素及对预后的影响。
创新点
探索糖尿病和(或)高血压患者行经导管主动脉瓣置换术后肾功能的变化及影响因素,这为部分患者术后肾功能变化提供临床管理依据。
方法
纳入242例重度主动脉瓣狭窄行经导管主动脉瓣置换术的糖尿病和(或)高血压患者,根据出院前估算肾小球滤过率(eGFR)与基线eGFR变化百分比分为3组:肾功能恢复组、肾功能无变化组以及肾功能恶化组。比较3组之间的临床基线数据和预后数据,并探索对术后肾功能改变的影响因素。 结论:结果发现,肾功能无变化组有更低的美国胸外科医师协会(STS)评分和更少的外周血管疾病合并症。肾功能改善组有更低的基线eGFR值、更低的左心室射血分数(LVEF)。肾功能恶化组住院期间和30天随访的死亡率均更高。肾功能改变的独立预测因素包括术前STS、LVEF、基线eGFR和预料外的体外循环发生率。在糖尿病和(或)高血压患者中,有接近40%的患者在经导管主动脉瓣置换术后肾功能得到改善。而肾功能恶化预示着更坏的临床结局。
结论
结果发现,肾功能无变化组有更低的美国胸外科医师协会(STS)评分和更少的外周血管疾病合并症. 肾功能改善组有更低的基线eGFR值、更低的左心室射血分数(LVEF). 肾功能恶化组住院期间和30天随访的死亡率均更高. 肾功能改变的独立预测因素包括术前STS、LVEF、基线eGFR和预料外的体外循环发生率. 在糖尿病和(或)高血压患者中,有接近40%的患者在经导管主动脉瓣置换术后肾功能得到改善. 而肾功能恶化预示着更坏的临床结局.
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Acknowledgments
This work was supported by the National Key R&D Program of China (Nos. 2019YFA0110400 and 2016YFC130 10204), the National Natural Science Foundation of China (Nos. 81870292, 81570233, and 81770252), the Key Social Development Program of Major Science and Technology Projects in Zhejiang Province (No. 2015C03028), and the Fundamental Research Funds for the Central Universities (No. 2019XZZX005-4-03), China.
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Jiaqi FAN and Changjie YU designed the research. Kaida REN and Wanbing LIN conducted experiments. Stella NG, Xinping LIN, Lihan WANG, Qifeng ZHU, Yuxin HE, and Jubo JIANG recruited patients, collected data, and entered the data. Jiaqi FAN and Zexin CHEN did the statistical analysis. Xianbao LIU and Jian’an WANG undertook a critical revision of the manuscript. All authors have read and approved the final manuscript and, therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
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Jiaqi FAN, Changjie YU, Kaida REN, Wanbing LIN, Stella NG, Zexin CHEN, Xinping LIN, Lihan WANG, Qifeng ZHU, Yuxin HE, Jubo JIANG, Xianbao LIU, and Jian’ an WANG declare that they have no conflicts of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.
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Fan, J., Yu, C., Ren, K. et al. Kidney function change after transcatheter aortic valve replacement in patients with diabetes and/or hypertension. J. Zhejiang Univ. Sci. B 22, 241–247 (2021). https://doi.org/10.1631/jzus.B2000431
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DOI: https://doi.org/10.1631/jzus.B2000431