-
摘要:
目的 探讨肺移植术后发生中心气道狭窄的危险因素。 方法 回顾性分析2016年7月至2017年12月在南京医科大学附属无锡人民医院接受肺移植的155例受者的临床资料。根据术后中心气道狭窄的发生情况，将受者分为狭窄组(36例)和对照组(119例)，总结肺移植术后中心气道狭窄的发生情况; 采用单因素和多因素logistic回归分析肺移植术后中心气道狭窄的危险因素。 结果 155例肺移植受者中，36例发生中心气道狭窄，发生率为23.2%，平均发生时间为术后(53±13)d。单因素分析结果显示，双肺移植、原发性移植物功能障碍(PGD) 3级、气道真菌感染、冷缺血时间长、机械通气时间长、重症监护室(ICU)入住时间长是肺移植术后发生中心气道狭窄的危险因素(均为P < 0.05)。多因素分析结果显示，气道真菌感染、冷缺血时间长、机械通气时间长是肺移植术后发生中心气道狭窄的独立危险因素(均为P < 0.05)。 结论 肺移植术后气道存在真菌感染及冷缺血时间、机械通气时间较长可能会导致肺移植术后中心气道狭窄。应采取积极措施预防，密切监测，以改善肺移植术后受者生存质量。 Abstract:Objective To investigate the risk factors of central airway stenosis after lung transplantation. Methods Clinical data of 155 recipients undergoing lung transplantation in Wuxi People's Hospital Affiliated to Nanjing Medical University from July 2016 to December 2017 were retrospectively analyzed. According to the incidence of central airway stenosis following lung transplantation, all recipients were divided into the stenosis group (n=36) and control group (n=119). The incidence of central airway stenosis after lung transplantation was summarized. The risk factors of central airway stenosis after lung transplantation were assessed by univariate and multivariate logistic regression analyses. Results Among 155 lung transplant recipients, 36 cases (23.2%) developed central airway stenosis. The average incidence time was (53±13) d after lung transplantation. Univariate analysis demonstrated that bilateral lung transplantation, grade 3 primary graft dysfunction (PGD), airway fungal infection, long cold ischemia time, long mechanical ventilation time and long intensive care unit (ICU) stay were the risk factors for central airway stenosis after lung transplantation (all P < 0.05). Multivariate analysis showed that airway fungal infection, long cold ischemia time and long mechanical ventilation time were the independent risk factors for central airway stenosis after lung transplantation (all P < 0.05). Conclusions Airway fungal infection after lung transplantation, long cold ischemia time and long mechanical ventilation time probably lead to central airway stenosis after lung transplantation. Active preventive measures and intimate monitoring should be taken to improve the quality of life of the recipients after lung transplantation. -
图 1 支气管吻合口狭窄分类图例
注：A图示右侧支气管吻合口狭窄(a类); B图示左侧支气管吻合口、左下叶支气管狭窄(b类)，伴曲霉感染。
Figure 1. Illustration of classification of bronchial anastomotic stenosis
表 1 肺移植术后中心气道狭窄危险因素的单因素分析
Table 1. Univariate analysis of risk factors of central airway stenosis after lung transplantation
变量 狭窄组(n=36) 对照组(n=119) P值 OR(95%CI) 年龄[M(P25，P75)，岁] 52(41，62) 58(50，64) 0.107 0.978(0.951~1.007) 性别[n(%)] 0.804 男 30(83) 97(82) 参照组 女 6(17) 22(18) 0.882(0.327~2.376) 原发病[n(%)] 0.183 肺纤维化 21(58) 63(53) 参照组 慢性阻塞性肺疾病 5(14) 25(21) 0.600(0.204~1.766) 支气管扩张 4(11) 7(6) 1.714(0.456~6.443) 硅沉着病 3(8) 12(10) 0.750(0.193~2.917) 特发性肺动脉高压 3(8) 2(2) 4.500(0.703~28.794) 肺淋巴管平滑肌瘤病 0 4(3) -① 其他 0 6(5) - 手术方式[n(%)] 0.023 单肺移植 18(50) 84(71) 参照组 双肺移植 18(50) 35(29) 2.400(1.119~5.148) PGD 3级[n(%)] 9(25) 12(10) 0.022 2.718(1.052~7.022) 气道真菌感染[n(%)] 14(39) 18(15) 0.002 3.571(1.546~8.246) 冷缺血时间(x±s，min) 479±116 419±104 0.004 4.213(1.775~10.002) 手术出血量[M(P25，P75)，mL] 1 200(800，1 750) 1 000(600，1 500) 0.086 1.000(1.000~1.001) 机械通气时间[M(P25，P75)，d] 2.0(1.0，5.8) 1.0(1.0，2.0) 0.003 4.909(1.937~12.443) ICU入住时间[M(P25，P75)，d] 5.0(3.0，6.8) 4.0(3.0，5.0) 0.030 1.078(1.022~1.138) 注：①-为无数据。 
下载: 导出CSV
表 2 肺移植术后中心气道狭窄危险因素的多因素分析
Table 2. 2 Multivariate analysis of risk factors of central airway stenosis after lung transplantation
变量 回归系数 统计量Wald OR值 95%CI P值 气道真菌感染 0.991 4.023 2.694 1.023~7.095 0.045 冷缺血时间 1.564 10.900 4.780 1.888~12.101 0.001 机械通气时间 1.084 4.060 2.957 1.030~8.488 0.044
下载: 导出CSV
-
[1] CRESPO MM, MCCARTHY DP, HOPKINS PM, et al. ISHLT consensus statement on adult and pediatric airway complications after lung transplantation: definitions, grading system, and therapeutics[J]. J Heart Lung Transplant, 2018, 37(5): 548-563. DOI: 10.1016/j.healun.2018.01.1309. [2] 杨航, 吴波, 陈静瑜, 等. 肺移植术后侵袭性支气管曲霉病20例临床分析[J]. 中华器官移植杂志, 2017, 38(8): 459-463. DOI: 10.3760/cma.j.issn.0254-1785.2017.08.003.YANG H, WU B, CHEN JY, et al. Invasive tracheobroncial aspergillosis in donation after citizen's death for lung transplantation: a series of 20 cases[J]. Chin J Organ Transplant, 2017, 38(8): 459-463. DOI: 10.3760/cma.j.issn.0254-1785.2017.08.003. [3] 孙敏, 李慧星, 谢于峰, 等. 单肺与双肺移植治疗特发性肺间质纤维化的临床研究[J]. 中华结核和呼吸杂志, 2016, 39(6): 444-449. DOI: 10.3760/cma.j.issn.1001-0939.2016.06.008.SUN M, LI HX, XIE YF, et al. Outcomes after singleversus bilateral lung transplantation for idiopathic pulmonary fibrosis[J]. Chin J Tuberc Respir Dis, 2016, 39(6): 444-449. DOI: 10.3760/cma.j.issn.1001-0939.2016.06.008. [4] SNELL GI, YUSEN RD, WEILL D, et al. Report of the ISHLT Working Group on primary lung graft dysfunction, part I: definition and grading-a 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation[J]. J Heart Lung Transplant, 2017, 36(10): 1097-1103. DOI: 10.1016/j.healun.2017.07.021. [5] FRYE L, MACHUZAK M. Airway complications after lung transplantation[J]. Clin Chest Med, 2017, 38(4): 693-706. DOI: 10.1016/j.ccm.2017.07.010. [6] NĘCKI M, LATOS M, URLIK M, et al. Number of bronchoscopic interventions in lung transplant recipients correlates with respiratory function assessed by pulmonary function tests[J]. Ann Transplant, 2021, 26: e927025. DOI: 10.12659/AOT.927025. [7] MAZZETTA A, PORZIO M, RIOU M, et al. Patients treated for central airway stenosis after lung transplantation have persistent airflow limitation[J]. Ann Transplant, 2019, 24: 84-92. DOI: 10.12659/AOT.911923. [8] ATCHADE E, YOUNSI M, ELMALEH Y, et al. Intensive care readmissions in the first year after lung transplantation: incidence, early risk factors and outcome[J]. Anaesth Crit Care Pain Med, 2021, 40(6): 100948. DOI: 10.1016/j.accpm.2021.100948. [9] CHAMOGEORGAKIS T, MOQUIN K, SIMOFF M, et al. Repair of bronchial anastomosis following lung transplantation[J]. Thorac Cardiovasc Surg, 2021, DOI: 10.1055/s-0041-1723002[Epubaheadofprint]. [10] BIN SAEEDAN M, RIZK A, YADAV R, et al. Imaging evaluation of airway complications after lung transplant[J]. J Comput Assist Tomogr, 2020, 44(3): 314-327. DOI: 10.1097/RCT.0000000000000996. [11] MENDOGNI P, CARRINOLA R, GHERZI L, et al. Usefulness of autofluorescence bronchoscopy in early diagnosis of airway complications after lung transplantation[J]. Sci Rep, 2020, 10(1): 22316. DOI: 10.1038/s41598-020-79442-4. [12] CALVERT AD, HAZELTON TR. Role of imaging in lung transplantation evaluation[J]. J Thorac Dis, 2020, 12(9): 5147-5158. DOI: 10.21037/jtd.2019.08.35. [13] DUTAU H, VANDEMOORTELE T, LAROUMAGNE S, et al. A new endoscopic standardized grading system for macroscopic central airway complications following lung transplantation: the MDS classification[J]. Eur J Cardiothorac Surg, 2014, 45(2): e33-e38. DOI: 10.1093/ejcts/ezt499. [14] KRAFT BD, MAHMOOD K, HARLAN NP, et al. Hyperbaric oxygen therapy to prevent central airway stenosis after lung transplantation[J]. J Heart Lung Transplant, 2021, 40(4): 269-278. DOI: 10.1016/j.healun.2021.01.008. [15] DAVIDSON KR, ELMASRI M, WAHIDI MM, et al. Management of lung transplant bronchial stenosis with mitomycin C[J]. J Bronchology Interv Pulmonol, 2019, 26(2): 124-128. DOI: 10.1097/LBR.0000000000000540. [16] MENDOGNI P, PIEROPAN S, ROSSO L, et al. Impact of cold ischemic time on airway complications after lung transplantation: a single-center cohort study[J]. Transplant Proc, 2019, 51(9): 2981-2985. DOI: 10.1016/j.transproceed.2019.04.092. [17] NĘCKI M, ANTOŃCZYK R, PANDEL A, et al. Impact of cold ischemia time on frequency of airway complications among lung transplant recipients[J]. Transplant Proc, 2020, 52(7): 2160-2164. DOI: 10.1016/j.transproceed.2020.03.047. [18] SHOFER SL, WAHIDI MM, DAVIS WA, et al. Significance of and risk factors for the development of central airway stenosis after lung transplantation[J]. Am J Transplant, 2013, 13(2): 383-389. DOI: 10.1111/ajt.12017. [19] SOETANTO V, GREWAL US, MEHTA AC, et al. Early postoperative complications in lung transplant recipients[J]. Indian J Thorac Cardiovasc Surg, 2021, DOI: 10.1007/s12055-021-01178-1 [Epub ahead of print]. [20] VAN DE WAUWER C, VAN RAEMDONCK D, VERLEDEN GM, et al. Risk factors for airway complications within the first year after lung transplantation[J]. Eur J Cardiothorac Surg, 2007, 31(4): 703-710. DOI: 10.1016/j.ejcts.2007.01.025. [21] HALPERN SE, AU S, KESSELI SJ, et al. Lung transplantation using allografts with more than 8 hours of ischemic time: a single-institution experience[J]. J Heart Lung Transplant, 2021, 40(11): 1463-1471. DOI: 10.1016/j.healun.2021.05.008. [22] HADEM J, GOTTLIEB J, SEIFERT D, et al. Prolonged mechanical ventilation after lung transplantation-a single-center study[J]. Am J Transplant, 2016, 16(5): 1579-1587. DOI: 10.1111/ajt.13632. [23] YSERBYT J, DOOMS C, VOS R, et al. Anastomotic airway complications after lung transplantation: risk factors, treatment modalities and outcome-a single-centre experience[J]. Eur J Cardiothorac Surg, 2016, 49(1): e1-e8. DOI: 10.1093/ejcts/ezv363. [24] PATOIR A, LUCHEZ A, TIFFET O, et al. Airway complications after lung transplantation: benefit of a conservative bronchoscopy strategy[J]. J Thorac Dis, 2020, 12(5): 2625-2634. DOI: 10.21037/jtd.2020.03.21. [25] NĘCKI M, GAWĘDA M, PANDEL A, et al. Microbiological status as a factor of airway complications after lung transplantation[J]. Transplant Proc, 2020, 52(7): 2149-2154. DOI: 10.1016/j.transproceed.2020.02.111. [26] PATTERSON TF, THOMPSON GR 3RD, DENNING DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2016, 63(4): e1-e60. DOI: 10.1093/cid/ciw326. [27] PARULEKAR AD, KAO CC. Detection, classification, and management of rejection after lung transplantation[J]. J Thorac Dis, 2019, 11(Suppl 14): S1732-S1739. DOI: 10.21037/jtd.2019.03.83. [28] GREER M, WERLEIN C, JONIGK D. Surveillance for acute cellular rejection after lung transplantation[J]. Ann Transl Med, 2020, 8(6): 410. DOI: 10.21037/atm.2020.02.127. -
下载:
点击查看大图
图(2) / 表(2)
计量
- 文章访问数: 223
- HTML全文浏览量: 109
- PDF下载量: 79
- 被引次数: 0
