de Pablo A, López S, Ussetti P, Carreño M C, Laporta R, López García-Gallo C, Ferreiro M J
Servicio de Neumología. Clínica Puerta de Hierro. Madrid. España.
Arch Bronconeumol. 2005 May;41(5):255-9. doi: 10.1016/s1579-2129(06)60219-x.
Lung transplantation is a valid therapeutic approach for patients with bronchiectasis. The objective of the present study was to evaluate our experience with bronchiectasis patients and compare the results in patients with cystic fibrosis to results in those with bronchiectasis caused by other processes.
We carried out a retrospective study of bronchiectasis patients treated by lung transplantation in order to analyze demographic, functional and microbiological characteristics before and after transplantation, and survival.
From 1991 to 2002 lung transplants were performed on 171 patients, 44 of whom had suppurative lung disease (27 had cystic fibrosis and 17 had bronchiectasis caused by other processes). There were no significant differences in the demographic variables between the 2 groups. At transplantation, lung function variables showed severe bronchial obstruction (mean [SD] forced expiratory volume in 1 second of 808 [342] mL and forced vital capacity of 1,390 [611] mL) and respiratory insufficiency (PaO2 at 52 [10] mm Hg and PaCO2 at 48 [9] mm Hg). Only PaO2 was significantly lower in patients with bronchiectasis from causes other than cystic fibrosis. Airway colonization was present in 91% of the patients; Pseudomonas spp germs were detected in 64% of the cases and were multiresistant in 9%. In the early postoperative period germs were isolated in 59% of the cases, half of which involved the same germ as had been isolated before transplantation. One year after lung transplantation, 34% of the patients continued to have bronchial colonization. Survival at 1 year was 79% and at 5 years, 49%, with no significant difference between the patients with cystic fibrosis and those with other suppurative diseases, nor between the patients with and without Pseudomonas colonization. Only 2 patients had died of bacterial pneumonia at 1 month after transplantation.
Although airway colonization in patients with suppurative diseases complicates postoperative management, the results in terms of survival are good.
肺移植是支气管扩张症患者的一种有效治疗方法。本研究的目的是评估我们治疗支气管扩张症患者的经验，并将囊性纤维化患者的结果与其他病因所致支气管扩张症患者的结果进行比较。
我们对接受肺移植治疗的支气管扩张症患者进行了一项回顾性研究，以分析移植前后的人口统计学、功能和微生物学特征以及生存率。
1991年至2002年，对171例患者实施了肺移植，其中44例患有化脓性肺病（27例为囊性纤维化，17例为其他病因所致支气管扩张症）。两组间人口统计学变量无显著差异。移植时，肺功能变量显示存在严重的支气管阻塞（一秒用力呼气量平均[标准差]为808[342]mL，用力肺活量为1390[611]mL）和呼吸功能不全（动脉血氧分压为52[10]mmHg，动脉血二氧化碳分压为48[9]mmHg）。仅非囊性纤维化所致支气管扩张症患者的动脉血氧分压显著较低。91%的患者存在气道定植；64%的病例检测到铜绿假单胞菌属细菌，其中9%为多重耐药菌。术后早期，59%的病例分离出细菌，其中一半涉及移植前分离出的相同细菌。肺移植术后1年，34%的患者仍有支气管定植。1年生存率为79%，5年生存率为49%，囊性纤维化患者与其他化脓性疾病患者之间、有或无铜绿假单胞菌定植的患者之间均无显著差异。仅2例患者在移植后1个月死于细菌性肺炎。
尽管化脓性疾病患者的气道定植使术后管理复杂化，但生存结果良好。
