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肺移植术后需要临床干预的气道狭窄患者生存结局的影响因素

史灵芝, 黄桁, 刘明昭, 等. 肺移植术后需要临床干预的气道狭窄患者生存结局的影响因素[J]. 器官移植, 2024, 15(2): 236-243. doi: 10.3969/j.issn.1674-7445.2023236
引用本文: 史灵芝, 黄桁, 刘明昭, 等. 肺移植术后需要临床干预的气道狭窄患者生存结局的影响因素[J]. 器官移植, 2024, 15(2): 236-243. doi: 10.3969/j.issn.1674-7445.2023236
Shi Lingzhi, Huang Heng, Liu Mingzhao, et al. Influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation[J]. ORGAN TRANSPLANTATION, 2024, 15(2): 236-243. doi: 10.3969/j.issn.1674-7445.2023236
Citation: Shi Lingzhi, Huang Heng, Liu Mingzhao, et al. Influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation[J]. ORGAN TRANSPLANTATION, 2024, 15(2): 236-243. doi: 10.3969/j.issn.1674-7445.2023236

肺移植术后需要临床干预的气道狭窄患者生存结局的影响因素

doi: 10.3969/j.issn.1674-7445.2023236
基金项目: 国家自然科学基金(82070059)
详细信息
    作者简介:
    通讯作者:

    田东(ORCID 0000-0001-8510-8309),博士,副教授,研究方向为肺移植基础与临床研究,Email: 22tiandong@163.com

    陈静瑜(ORCID 0000-0002-2127-1788),博士,主任医师,教授,研究方向为肺移植,Email: chenjy@wuxiph.com

  • 中图分类号: R617, R562.1+2

Influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation

More Information
  • 摘要:   目的  分析肺移植术后需要临床干预的气道狭窄患者生存结局的影响因素。  方法  回顾性分析肺移植术后需要临床干预的66例气道狭窄患者的临床资料。采用单因素和多因素Cox回归模型分析所有气道狭窄患者和早期气道狭窄患者生存结局的影响因素,采用Kaplan-Meier法计算总生存率并绘制生存曲线。  结果  66例气道狭窄患者,中位无气道狭窄时间为72(52,102)d,27%(18/66)发生中心气道狭窄,73%(48/66)发生远端气道狭窄。术后机械通气时间[风险比(HR)1.037,95%可信区间(CI)1.005~1.070,P=0.024]和手术类型(HR 0.400,95% CI 0.177~0.903,P=0.027)均与肺移植术后气道狭窄患者的生存结局存在相关性,术后机械通气时间越长,受者死亡风险越高;接受双肺移植的气道狭窄患者的总生存率优于单肺移植。在亚组分析中,3级原发性移植物失功(PGD)(HR 4.577,95% CI 1.439~14.555,P=0.010)和免疫抑制药(HR 0.079,95% CI 0.022~0.287,P<0.001)与肺移植术后早期气道狭窄患者生存结局均存在相关性;无3级PGD的肺移植术后早期气道狭窄患者的总生存率优于有3级PGD的患者,使用他克莫司的肺移植术后早期气道狭窄患者的总生存率优于使用环孢素的患者。  结论  术后机械通气时间长、单肺移植手术方式、3级PGD和使用环孢素可能影响肺移植术后气道狭窄患者的生存。

     

  • FIG. 2994.  FIG. 2994.

    FIG. 2994..  FIG. 2994.

    图  1  不同手术类型对气道狭窄患者总生存率影响的Kaplan-Meier曲线

    Figure  1.  The Kaplan-Meier curves of effects of different surgical types on overall survival rate of patients with airway stenosis

    图  2  3级PGD对早期气道狭窄患者总生存率影响的Kaplan-Meier曲线

    Figure  2.  The Kaplan-Meier curves of effects of grade 3 PGD on overall survival rate of patients with early airway stenosis

    图  3  不同免疫抑制药对早期气道狭窄患者总生存率影响的Kaplan-Meier曲线

    Figure  3.  The Kaplan-Meier curves of effects of different immunosuppressive drugs on overall survival rate of patients with early airway stenosis

    表  1  肺移植术后气道狭窄患者生存结局的单因素和多因素分析

    Table  1.   Univariate and multivariate analysis of survival outcomes in patients with airway stenosis after lung transplantation

    变量 气道狭窄患者(n=66) 单因素分析 多因素分析
    HR(95%CI P HR(95%CI P
    性别[n(%)]
     男 54(82) 参照值
     女 12(18) 1.513(0.571~4.009) 0.405
    年龄[MP25P75),岁] 55(48,61) 1.028(0.992~1.065) 0.131
    BMI($\bar x $±s,kg/m2 20±4 1.070(0.976~1.172) 0.149
    供者末次氧合指数[MP25P75),mmHg] 435(390,466) 1.004(0.998~1.010) 0.192
    冷缺血时间[MP25P75),h] 7.1(5.6,8.1) 0.916(0.755~1.111) 0.373
    手术类型[n(%)] 0.400(0.177~0.903) 0.027
     单肺移植 32(48) 参照值
     双肺移植 34(52) 0.433(0.196~0.959) 0.039
    手术时间[MP25P75),h] 5.7(4.4,6.7) 0.917(0.745~1.128) 0.412
    ECMO使用[n(%)] 43(65) 0.953(0.439~2.066) 0.902
    术后机械通气时间[MP25P75),d] 2.0(1.0,2.8) 1.030(1.000~1.061) 0.050 1.037(1.005~1.070) 0.024
    术后ICU入住时间[MP25P75),d] 5(3,6) 0.998(0.960~1.038) 0.920
    无气道狭窄时间[MP25P75),d] 72(52,102) 0.999(0.991~1.008) 0.875
    狭窄位置[n(%)]
     中心气道狭窄 18(27) 参照值
     远端气道狭窄 48(73) 0.793(0.358~1.755) 0.567
    术后FEV1/FVC[MP25P75),%] 80(69,91) 1.704(0.385~7.541) 0.482
    术后6MWT[MP25P75),m] 450(335,538) 1.001(0.997~1.004) 0.756
    3级PGD[n(%)] 11(17) 1.824(0.774~4.301) 0.170
    免疫抑制药[n(%)]
     环孢素 12(18) 参照值
     他克莫司 54(82) 0.517(0.219~1.222) 0.133
      注:①1 mmHg=0.133kPa。
    下载: 导出CSV

    表  2  肺移植术后早期气道狭窄患者生存结局的单因素和多因素分析

    Table  2.   Univariate and multivariate analysis of survival outcomes in patients with early airway stenosis after lung transplantation

    变量 早期气道狭窄患者
    n=40)
    单因素分析 多因素分析
    HR(95%CI P HR(95%CI P
    性别[n(%)]
     男 32(80) 参照值
     女 8(20) 1.642(0.536~5.031) 0.385
    年龄[MP25P75),岁] 54(44,61) 1.015(0.972~1.059) 0.495
    BMI($\bar x $±s,kg/m2 20±8 1.081(0.978~1.194) 0.127
    供者末次氧合指数
    [MP25P75),mmHg]
    449(403,473) 1.003(0.995~1.010) 0.464
    冷缺血时间[MP25P75),h] 8.0(6.8,9.0) 0.876(0.678~1.133) 0.314
    手术类型[n(%)]
     单肺移植 19(48) 参照值
     双肺移植 21(52) 0.621(0.249~1.545) 0.306
    手术时间[MP25P75),h] 5.7(4.5,6.8) 0.929(0.747~1.154) 0.505
    ECMO使用[n(%)] 28(70) 0.879(0.334~2.315) 0.794
    术后机械通气时间
    [MP25P75),d]
    2(1,3) 1.028(0.998~1.060) 0.068 1.023(0.988~1.058) 0.198
    术后ICU入住时间[MP25P75),d] 5(3,6) 1.003(0.966~1.040) 0.888
    无气道狭窄时间[MP25P75),d] 55(45,69) 0.997(0.973~1.022) 0.828
    狭窄位置[n(%)]
     中心气道狭窄 9(22) 参照值
     远端气道狭窄 31(78) 0.589(0.224~1.551) 0.284
    术后FEV1/FVC[MP25P75),%] 81(69,91) 0.946(0.183~4.885) 0.947
    术后6MWT[MP25P75),m] 482(360,542) 0.999(0.996~1.003) 0.663
    3级PGD[n(%)] 7(18) 2.707(1.020~7.180) 0.045 4.577(1.439~14.555) 0.010
    免疫抑制药[n(%)] 0.079(0.022~0.287) <0.001
     环孢素 7(17) 参照值
     他克莫司 33(83) 0.147(0.048~0.451) 0.001
      注:①1 mmHg=0.133kPa。
    下载: 导出CSV
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  • 收稿日期:  2023-11-07
  • 网络出版日期:  2024-01-18
  • 刊出日期:  2024-03-15

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