肺移植受者术后肺功能的变化特点

蔡宇航; 练巧燕; 王晓华; 陈奥; 王璐琳; 杨雅兰; 徐钰; 何建行; 巨春蓉

doi:10.3969/j.issn.1674-7445.2023092

肺移植受者术后肺功能的变化特点

doi: 10.3969/j.issn.1674-7445.2023092

1.
510012　广州，广州医科大学呼吸疾病国家重点实验室
2.
广州医科大学附属第一医院广州呼吸健康研究院
3.
广州医科大学附属第五医院

基金项目: 广东省自然科学基金（2022A1515012216）；广州呼吸健康研究所基金（2019GIRHZ04）；广东省钟南山医学基金（ZNSA-2020013）；广州呼吸健康研究院基础研究计划（202201020371）

详细信息

作者简介:

通讯作者:
巨春蓉（ORCID：0000-0001-9041-874X），主任医师，教授，博士研究生导师，研究方向为终末期肺疾病肺移植术前评估与术后并发症诊治，Email：juchunrong@126.com

中图分类号: R617, R563
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出版历程
- 收稿日期: 2023-04-25
- 录用日期: 2023-07-07
- 网络出版日期: 2023-07-20
- 刊出日期: 2023-09-15

Changes of postoperative pulmonary function in lung transplant recipients

1.
State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou 510012, China

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Corresponding author: Ju Chunrong, Email: juchunrong@126.com

摘要

摘要: 目的分析肺移植受者术后肺功能的变化特点。方法收集81例行双肺移植及心肺联合移植受者的临床资料，分析受者术后一般情况。分析肺移植受者术后1个月、3个月、每3个月（术后3~18个月）以及每6个月（术后18~36个月）肺通气及弥散功能指标。分析受者术后的最佳肺功能特点。结果受者术后机械通气时间为4（2，9）d，术后重症监护室入住时间为10（7，20）d。81例受者中，27例术后发生原发性移植物功能障碍（PGD），发生率为33%。受者术后用力肺活量（FVC）占预计值百分比（FVC%pred）、第1秒用力呼气容积（FEV₁）占预计值百分比（FEV₁%pred）、FEV₁/FVC占预计值百分比（FEV₁/FVC%pred）、校正后肺一氧化碳弥散功能占预计值百分比（D_LCOc%pred）随时间发生变化（均为P<0.001）。FVC%pred、FEV₁%pred在术后9个月内逐渐上升，D_LCOc%pred在术后3个月内逐渐上升（均为P<0.05）。FVC%pred≥80%者36例，FEV₁%pred≥80%者41例，FEV₁/FVC%pred≥92%者76例；FVC%pred≤40%者1例，FEV₁%pred≤40%者1例。D_LCOc%pred≥80%者16例，校正后肺一氧化碳弥散功能/肺泡容量占预计值百分比（D_LCOc/V_A%pred）≥80%者63例；D_LCOc%pred≤40%者4例，D_LCOc/V_A%pred≤40%者1例。原发病为阻塞性肺疾病的受者术后FVC%pred、FEV₁/FVC%pred、D_LCOc%pred均高于原发病为限制性肺疾病的受者（均为P<0.05）。发生PGD的受者术后D_LCOc%pred低于未发生PGD的受者（P<0.05）。结论肺移植受者肺通气功能在术后9个月达到最佳状态且达到稳态，肺弥散功能在术后3个月达到稳态，原发病以及是否发生PGD可能对术后肺功能存在影响。
- 肺移植 /
- 肺通气功能 /
- 肺弥散功能 /
- 阻塞性肺疾病 /
- 限制性肺疾病 /
- 原发性移植物功能障碍 /
- 慢性移植肺功能障碍 /
- 排斥反应
Abstract: Objective To analyze the changes of postoperative pulmonary function in lung transplant recipients. Methods Clinical data of 81 recipients undergoing bilateral lung transplantation and combined heart-lung transplantation were collected, and postoperative status of the recipients was analyzed. Pulmonary ventilation and diffusion function indexes at 1 month, 3 months, every 3 months (3-18 months after lung transplantation) and every 6 months (18-36 months after lung transplantation) were analyzed in the recipients. The characteristics of the optimal pulmonary function in the recipients were assessed. Results Postoperative mechanical ventilation time was 4 (2, 9) d, and the length of postoperative ICU stay was 10 (7, 20) d. Among 81 recipients, 27 recipients developed primary graft dysfunction (PGD) after lung transplantation, with an incidence rate of 33%. Postoperative forced vital capacity (FVC) to predicted value ratio (FVC%pred), forced expiratory volume in one second (FEV₁) to predicted value ratio (FEV₁%pred), FEV₁/FVC to predicted value ratio (FEV₁/FVC%pred) and corrected diffusion lung capacity for CO to predicted value ratio (D_LCOc%pred) were changed over time (all P<0.001). FVC%pred and FEV₁%pred were gradually increased within postoperative 9 months, and D_LCOc%pred was gradually elevated within postoperative 3 months (all P<0.05). Thirty-six recipients had FVC%pred≥80%, FEV₁%pred≥80% in 41 cases, FEV₁/FVC%pred≥92% in 76 cases, FVC%pred≤40% in 1 case and FEV₁%pred≤40% in 1 case, respectively. Sixteen recipients had D_LCOc%pred≥80%, corrected diffusion lung capacity for CO/alveolar volume to predicted value ratio (D_LCOc/V_A%pred) ≥80% in 63 cases, D_LCOc%pred≤40% in 4 cases and D_LCOc/V_A%pred≤40% in 1 case, respectively. Postoperative FVC%pred, FEV₁/FVC%pred and D_LCOc%pred in recipients with a primary disease of obstructive pulmonary disease were significantly higher than those in their counterparts with restrictive pulmonary disease (all P<0.05). Postoperative D_LCOc%pred in recipients with PGD was significantly lower than that in those without PGD (P<0.05). Conclusions Pulmonary ventilation function in lung transplant recipients reaches the optimal state and maintains a steady state at postoperative 9 months, and pulmonary diffusion function reaches a steady state at postoperative 3 months. Primary diseases and the incidence of PGD may affect postoperative pulmonary function.
- Lung transplantation /
- Pulmonary ventilation function /
- Pulmonary diffusion function /
- Obstructive pulmonary disease /
- Restrictive pulmonary disease /
- Primary graft dysfunction /
- Chronic lung allograft dysfunction /
- Rejection

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图 1 肺移植受者术后肺通气功能动态变化

Figure 1. Dynamic changes of postoperative pulmonary ventilation function in lung transplant recipients

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图 2 肺移植受者术后肺弥散功能动态变化

Figure 2. Dynamic changes of postoperative pulmonary diffusion function in lung transplant recipients

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图 3 肺移植受者最佳肺通气功能的频数分布

Figure 3. Frequency distribution of optimal pulmonary ventilation function in lung transplant recipients

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图 4 肺移植受者最佳肺弥散功能的频数分布

Figure 4. Frequency distribution of optimal pulmonary diffusion function in lung transplant recipients

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表 1 阻塞性肺疾病与限制性肺疾病受者最佳肺功能比较

Table 1. Comparison of optimal pulmonary function between recipients with obstructive pulmonary disease and restrictive pulmonary disease ($\bar {\boldsymbol{x}} $±s,%)

肺功能	阻塞性肺疾病（n=33）	限制性肺疾病（n=48）	统计值	P值
肺通气功能
FEV₁%pred	85±20	76±21	−1.99	0.04
FVC%pred	78±16	78±18	−1.07	0.27
FEV₁/FVC%pred	109±11	104±14	−2.18	0.02
肺弥散功能
D_LCOc%pred	72±18	62±16	−2.67	<0.01
D_LCOc/V_A%pred	94±18	92±19	−0.44	0.66

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表 2 发生PGD与未发生PGD受者最佳肺功能比较

Table 2. Comparison of optimal pulmonary function between recipients with and without PGD ($\bar {\boldsymbol{x}} $±s,%)

肺功能	发生PGD（n=27）	未发生PGD（n=54）	统计值	P值
肺通气功能
FEV₁%pred	75±20	82±22	1.54	0.13
FVC%pred	72±17	74±19	1.46	0.14
FEV₁/FVC%pred	105±11	107±14	−0.62	0.60
肺弥散功能
D_LCOc%pred	61±14	69±19	2.00	0.04
D_LCOc/V_A%pred	89±15	95±19	1.46	0.14

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