慢性移植肺功能障碍的诊断与治疗现状

黄桁; 田东

doi:10.3969/j.issn.1674-7445.2021.05.004

慢性移植肺功能障碍的诊断与治疗现状

doi: 10.3969/j.issn.1674-7445.2021.05.004

黄桁,
田东^,

637000 四川南充，川北医学院附属医院心肺移植研究室川北医学院附属医院院士(专家)工作站川北医学院医学影像四川省重点实验室

基金项目:

医学影像四川省重点实验室开放课题 MIKLSP202007

南充市杰出青年科技人才专项 20SXJCQN0002

川北医学院附属医院博士科研启动基金 2021BK01

川北医学院附属医院科研发展计划项目 2021ZK003

详细信息

作者简介:
黄桁，男，1997年生，硕士研究生，研究方向为肺移植基础与临床研究，Email：seven_74521@163.com

田东，日本东京大学外科学博士(肺外科)，四川大学外科学博士(食管外科)，川北医学院附属医院副主任医师。主要从事肺移植、食管癌、肺癌、纵隔肿瘤的基础和临床工作。美国The University of Toledo Medical Center(UTMC)访问学者，加拿大多伦多大学总医院Training Fellow，日本京都大学Research Fellow。美国胸外科协会(AATS) Graham Training Fellowship获得者。主持省部级科研课题多项，以第一或者通信作者身份发表中文/科技核心论文30余篇、SCI论文30余篇，负责国家专利7项，主(参)编(译)医学专著7部。获中华医学会胸心血管外科全国十佳优秀论文二等奖和四川省医学会青年优秀论文奖。受邀参加国际、国内学术年会等并做大会发言30余次

通讯作者:
田东，E-mail: TianD_EATTS@nsmc.edu.cn

中图分类号: R617, R563
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出版历程
- 收稿日期: 2021-05-22
- 网络出版日期: 2021-09-15
- 刊出日期: 2021-09-15

Current status of diagnosis and treatment of chronic lung allograft dysfunction

Huang Heng,
Tian Dong^,

Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Academician (Expert) Workstation, Affiliated Hospital of North Sichuan Medical College, Medical Imaging Key Laboratory of Sichuan Province, North Sichuan Medical College, Nanchong 637000, China

More Information

Corresponding author: Tian Dong, E-mail: TianD_EATTS@nsmc.edu.cn

摘要

摘要: 慢性移植肺功能障碍(CLAD)是影响肺移植受者远期生存的最大阻碍，代表了一系列术后移植肺功能显著且持续恶化的复杂临床表现。由于缺乏有效的早期诊断和预防策略，一半以上的肺移植受者在5年内会出现CLAD，且这一比例将在10年内提高到75%。目前没有任何药物可以完全阻止或逆转CLAD的进展。近年来，随着2019年国际心肺移植学会(ISHLT)更新了CLAD的定义、诊断和治疗，国际上对CLAD的认识有了较大提高。本文将对CLAD的综合诊断方式和潜在治疗策略进行详细总结，为CLAD发生、发展的早期监测和管理提供理论参考和见解。
- 肺移植 /
- 慢性移植肺功能障碍 /
- 闭塞性细支气管炎综合征 /
- 限制性移植物综合征 /
- 供者来源性细胞游离DNA /
- 阿奇霉素 /
- 孟鲁司特 /
- 吡非尼酮
Abstract: Chronic lung allograft dysfunction (CLAD) is the largest obstacle to the long-term survival of lung transplant recipients, which represents a series of complicated clinical manifestations of significant and persistent deterioration of lung allograft function after surgery. Due to lack of effective strategies for early diagnosis and prevention, over half of lung transplant recipients will develop CLAD within postoperative 5 years, which is likely to increase to 75% within postoperative 10 years. At present, no drug can be administered to completely prevent or reverse the progression of CLAD. In recent years, since the definition, diagnosis and treatment of CLAD have been updated by International Society of Heart and Lung Transplantation (ISHLT) in 2019, the understanding of CLAD has been significantly deepened within the international community. In this article, comprehensive diagnostic methods and potential treatment strategies of CLAD were explicitly illustrated, aiming to provide theoretical reference and insights for early monitoring and management of the incidence and progression of CLAD.
- Lung transplantation /
- Chronic lung allograft dysfunction /
- Bronchiolitis obliterans syndrome /
- Restrictive allograft syndrome /
- Donor-derived cell-free DNA /
- Azithromycin /
- Montelukast /
- Pirfenidone

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图 1 BOS和RAS的组织学典型特征

注：A图为BOS的组织学典型特征(苏木素-伊红，×100)；B图为RAS的组织学典型特征(苏木素-伊红，×200)。

Figure 1. Typical histological features of BOS and RAS

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图 2 BOS和RAS受者的胸部CT检查典型特征

注：A图为BOS受者的胸部CT检查典型特征；B图为RAS受者的胸部CT检查典型特征。

Figure 2. Typical features of chest CT in recipients with BOS and RAS

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表 1 CLAD四种基本表型的诊断和鉴别指标

Table 1. Diagnosis and differential indicators of the four basic phenotypes of CLAD

表型	阻塞型通气缺陷^①	限制型通气缺陷^②	CT浑浊^③
BOS型	有	无	无
RAS型	无	有	有
混合型④	有	有	有
未定义型⑤	有	无	有
未定义型⑤	有	有	无
注：①阻塞型通气缺陷定义为FEV₁相对基线值下降≥20%，且FEV₁/FVC < 70%。 ②限制型通气缺陷定义为TLC相对基线值降低≥10%。 ③CT浑浊指与肺和(或)胸膜纤维化诊断一致的实质混浊和(或)胸膜增厚，导致限制性生理变化。 ④所有BOS表型和RAS表型相互转化的病例，且具有两种组织病理学表现。 ⑤有着明确的CLAD定义，但有两种可能的表型组合，使得很难归类为BOS、RAS或混合表型。

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