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  

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

作　　者：史灵芝 黄桁 刘明昭 杨航 吴波 赵晋 严浩吉 左玉洁 张馨月[3] 刘霖曦 田东 陈静瑜 Shi Lingzhi;Huang Heng;Liu Mingzhao;Yang Hang;Wu Bo;Zhao Jin;Yan Haoji;Zuo Yujie;Zhang Xinyue;Liu Linxi;Tian Dong;Chen Jingyu(Wuxi Medical Center,Nanjing Medical University,Wuxi People's Hospital,Department of Lung Transplant Center,the Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,China;不详)

机构地区：[1]南京医科大学无锡医学中心无锡市人民医院南京医科大学附属无锡人民医院肺移植中心,江苏无锡214023 [2]四川大学华西医院胸外科 [3]四川大学华西医院胸部肿瘤研究所肺移植研究室 [4]浙江大学医学院附属第二医院肺移植科

出　　处：《器官移植》2024年第2期236-243,共8页Organ Transplantation

基　　金：国家自然科学基金(82070059)。

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%CI0.022~0.287,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。Objective To analyze the influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation.Methods Clinical data of 66 patients with airway stenosis requiring clinical interventions after lung transplantation were retrospectively analyzed.Univariate and multivariate Cox's regression models were adopted to analyze the influencing factors of survival of all patients with airway stenosis and those with early airway stenosis.Kaplan-Meier method was used to calculate the overall survival and delineate the survival curve.Results For 66 patients with airway stenosis,the median airway stenosis-free time was 72(52,102)d,27%(18/66)for central airway stenosis and 73%(48/66)for distal airway stenosis.Postoperative mechanical ventilation time[hazard ratio(HR)1.037,95%confidence interval(CI)1.005-1.070,P=0.024]and type of surgery(HR 0.400,95%CI 0.177-0.903,P=0.027)were correlated with the survival of patients with airway stenosis after lung transplantation.The longer the postoperative mechanical ventilation time,the higher the risk of mortality of the recipients.The overall survival of airway stenosis recipients undergoing bilateral lung transplantation was better than that of their counterparts after single lung transplantation.Subgroup analysis showed that grade 3 primary graft dysfunction(PGD)(HR 4.577,95%CI 1.439-14.555,P=0.010)and immunosuppressive drugs(HR 0.079,95%CI 0.022-0.287,P<0.001)were associated with the survival of patients with early airway stenosis after lung transplantation.The overall survival of patients with early airway stenosis after lung transplantation without grade 3 PGD was better compared with that of those with grade 3 PGD.The overall survival of patients with early airway stenosis after lung transplantation treated with tacrolimus was superior to that of their counterparts treated with cyclosporine.Conclusions Long postoperative mechanical ventilation time,single lung transplantation,grade 3 PGD and use of cyclosporine may affect the survi

关 键 词：肺移植 气道狭窄 气道并发症 原发性移植物失功(PGD) 急性排斥反应 体外膜肺氧合 氧合指数 机械通气 单肺移植 双肺移植 

分 类 号：R617[医药卫生—外科学] R562.12[医药卫生—临床医学]