Al-Rawas O A, Carter R, Stevenson R D, Naik S K, Wheatley D J
Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow G31 2ES, UK.
Heart. 2000 Feb;83(2):156-60. doi: 10.1136/heart.83.2.156.
To determine the mechanism of impairment of pulmonary transfer factor for carbon monoxide (TL(CO)) in heart transplant candidates, as this is the most common lung function abnormality.
Regional cardiopulmonary transplant centre.
TL(CO) and its components (the diffusing capacity of the alveolar-capillary membrane (D(M)) and the pulmonary capillary blood volume (V(C))) were measured using the Roughton and Forster method and the single breath technique in 38 patients with severe chronic heart failure awaiting heart transplantation (mean age 51 years, range 19 to 61; mean left ventricular ejection fraction 12.8%). Results were compared with data from 26 normal subjects (mean age 47 years, range 27 to 62).
Mean per cent predicted TL(CO), D(M), and V(C) were significantly reduced in patients (69.9%, 81.4%, and 80.2% of predicted, respectively) compared with controls (97.7%, 100.1%, and 102.3% of predicted, respectively, p < 0.001). The relative contribution of the two components of TL(CO) in patients was similar to that of normal subjects, with each component accounting for approximately 50% of the total resistance to diffusion (1/TL(CO)).
TL(CO) impairment in patients with severe chronic heart failure awaiting heart transplantation results from a proportionate reduction in both D(M) and V(C), suggesting a significant disturbance of the pulmonary vascular bed.
确定等待心脏移植者一氧化碳肺转移因子（TL(CO)）受损的机制，因为这是最常见的肺功能异常。
地区心肺移植中心。
采用Roughton和Forster方法及单次呼吸技术，对38例等待心脏移植的严重慢性心力衰竭患者（平均年龄51岁，范围19至61岁；平均左心室射血分数12.8%）测量TL(CO)及其组成部分（肺泡-毛细血管膜弥散量（D(M)）和肺毛细血管血容量（V(C)））。将结果与26名正常受试者（平均年龄47岁，范围27至62岁）的数据进行比较。
与对照组相比，患者的平均预计TL(CO)、D(M)和V(C)显著降低（分别为预计值的69.9%、81.4%和80.2%），而对照组分别为预计值的97.7%、100.1%和102.3%（p<0.001）。患者中TL(CO)两个组成部分的相对贡献与正常受试者相似，每个组成部分约占总扩散阻力（1/TL(CO)）的50%。
等待心脏移植的严重慢性心力衰竭患者的TL(CO)受损是由于D(M)和V(C)均成比例降低，提示肺血管床存在明显紊乱。
