肺移植后闭塞性细支气管炎的研究进展  

Research progress of bronchiolitis obliterans after lung transplantation

作　　者：蒋根宜 段江南 吴亮[1] JIANG Genyi;DUAN Jiangnan;WU Liang(Department of Thoracic Surgery,Shanghai Pulmonary Hospital affiliated to Tongji University,Shanghai 200433,China)

机构地区：[1]同济大学附属上海市肺科医院胸外科,上海200433

出　　处：《上海医药》2020年第18期7-10,共4页Shanghai Medical & Pharmaceutical Journal

基　　金：国家自然科学基金资助项目(81970092)。

摘　　要：肺移植是终末性肺部疾病有效的治疗手段,近年来得到愈为广泛的应用,从首次实施人肺移植受者,经半世纪的发展,肺移植在移植肺的保存、供受者匹配、免疫抑制治疗以及围手术期处理等方面都有显著成果,使肺移植受者术后短期生存率明显提高。然而,肺移植术后的长期生存率,却因闭塞性细支气管炎(obliterative bronchiolitis,OB)的发生而受到限制。OB是一种累及肺部小气道的炎症及纤维增生性病变,其临床表现为闭塞性细支气管炎综合征(bronchiolitis obliterans syndrome,BOS),且随肺移植术后时间年限增长,发生率也显著增加。传统观点认为,OB是肺移植后慢性排斥反应的表现形式。但最新研究表明,OB的发生受多种因素影响,包括固有免疫的过度激活、血管异常增生重塑、正常上皮再生障碍及纤维组织异常增生重塑等。全文就近十年国内外有关肺移植后OB的研究进展进行综述。Lung transplantation is an effective treatment for terminal lung disease,and has been widely used in recent years.Since the first implementation of human lung transplantation,after half a century of development,lung transplantation has achieved remarkable results in the preservation of transplanted lungs,donor-recipient matching,immunosuppressive therapy,and perioperative management so that the short-term survival rate after lung transplantation is significantly improved.However,the long-term survival rate after lung transplantation is limited by the occurrence of obliterative bronchiolitis(OB).OB is an inflammatory and fibroproliferative lesion involving small airways of the lung,its clinical manifestation is bronchiolitis obliterans syndrome(BOS),and the incidence rate increases significantly with the time after lung transplantation.The traditional view is that OB is a manifestation of chronic rejection after lung transplantation.However,the latest research shows that the occurrence of OB is affected by many factors,including excessive activation of innate immunity,abnormal vascular proliferation and remodeling,normal epithelial aplasia,and abnormal fibrous tissue remodeling.This article reviews the research progress of OB after lung transplantation at home and abroad in recent ten years.

关 键 词：闭塞性细支气管炎 肺移植 生存率 

分 类 号：R562.21[医药卫生—呼吸系统]