在接受心脏移植的患者中,血清肌素是功能不可靠的标志物
Maria Tholén1, Lukas Lannemyr1, Hasse Møller-Sørensen2
1Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Acta anaesthesiologica Scandinavica
|February 27, 2024
概括
估计的淋巴细胞过率 (eGFR) 对于评估心脏移植后早期的功能 (Htx) 是不准确的. 测量GFR (mGFR) 对于可靠评估Htx后功能至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 心脏病学 心脏病学
- 移植医学 移植医学
背景情况:
- 功能障碍是心脏移植 (Htx) 后的常见并发症.
- 淋巴膜过率 (GFR) 是功能的一个关键指标.
- 估计方程 (eGFR) 通常用于从血清肌氨酸中近似估计GFR,但其Htx后的准确性是不确定的.
研究的目的:
- 评估心脏移植后早期患者估计GFR (eGFR) 与测量GFR (mGFR) 的相关性,一致性和准确性.
- 评估eGFR能够跟踪mGFR在Htx.之后的早期术后期的变化的能力.
主要方法:
- 一项前性观察性研究,涉及55名接受Htx.治疗的患者.
- 血清肌素和mGFR (使用Cr51-EDTA或IOHEXOL清除率) 在术前和术后4天测量.
- 准确性被定义为eGFR在mGFR (P30) 30%以内的患者的百分比;使用布兰德-阿尔特曼分析和四象限图进行评估.
主要成果:
- 在预测mGFR时,eGFR的准确性仅为52%,偏差为11.2±17.4毫升/分钟/1.72米2.
- 达成一致的界限很宽 (-23.0至45.4毫升/分钟/1.72米),表明达成一致的程度很低,并存在实质性的集团间错误 (58%).
- 在eGFR和mGFR之间的一致率为72%,而eGFR在术后跟踪mGFR变化的能力很差.
结论:
- 估计的GFR (eGFR) 显著低估了心脏移植后早期测量的GFR (mGFR).
- 低准确度,差异一致性和跟踪变化的不可靠性表明,eGFR方程不足以评估Htx后的功能.
- 直接测量GFR (mGFR) 是必要的,以准确评估心脏移植后的关键早期时期的功能.
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