Weinstein Michael S, Martin Ubaldo J, Crookshank Aaron D, Chatila Wissam, Vance Gwendolyn B, Gaughan John P, Furukawa Satoshi, Criner Gerard J
Divisions of Pulmonary and Critical Care Medicine and Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
COPD. 2007 Mar;4(1):15-22. doi: 10.1080/15412550601168705.
The purpose of this endeavor is to compare the morbidity, mortality and costs of LVRS versus transplantation in severe emphysema. This was a retrospective review of severe emphysema patients who received LVRS (n = 70) from 1994-1999, or transplant (n = 87) from 1994-2004. Change in functional status was calculated by the change in modified BODE (mBODE) score. Financial data included physician, hospital and medication costs. Preoperatively, there was no significant difference between the transplant and LVRS groups (mean +/- SD) in age (57.7 +/- 5.7 vs. 59.1 +/- 8.3 years), BMI, Borg dyspnea score, 6-minute walk distance or mBODE (10.4 +/- 2.6 vs. 9.6 +/- 2.7, p = 0.4). Preoperatively, FEV1% (23.6 +/- 8.5 vs. 31.9 +/- 17.7, p = 0.008) was significantly lower in the transplant group. One year post-operatively, transplantation patients had a significantly greater improvement in mBODE (-5.7 vs. -2.0, p = 0.0004), FEV1% (43.4 vs. 2.2%, p = 0.0004) and Borg score (-3.0 vs. -1.4, p = 0.04). Transplantation patients had lower long-term survival compared to LVRS patients (p = 0.01). The only variable that affected survival was type of surgery favoring LVRS (hazard ratio 1.7, 95% confidence limits 1.05-2.77). During a mean follow-up of 2.4 +/- 2.5 years after transplant and 5.0 +/- 3.1 years after LVRS, transplantation mean total costs were greater ($381,732 vs. $140,637, p < 0.0001). Transplantation patients spent more time in the hospital (74.3 +/- 81.3 vs. 39.5 +/- 66.7 days, p = 0.009) and had more outpatient visits (29.9 +/- 28.8 vs. 12.3 +/- 12.6 visits, p < 0.0001). In patients who survive over 1 year, transplantation provides a higher level of functional status and a greater improvement in airflow obstruction, dyspnea, exercise tolerance, and mBODE score, but costs more and carries greater mortality.
本研究旨在比较重度肺气肿患者接受肺减容术（LVRS）与肺移植的发病率、死亡率和成本。这是一项对1994年至1999年接受LVRS（n = 70）或1994年至2004年接受肺移植（n = 87）的重度肺气肿患者的回顾性研究。功能状态的变化通过改良BODE（mBODE）评分的变化来计算。财务数据包括医生、医院和药物成本。术前，移植组和LVRS组在年龄（57.7±5.7岁 vs. 59.1±8.3岁）、体重指数、Borg呼吸困难评分、6分钟步行距离或mBODE（10.4±2.6 vs. 9.6±2.7，p = 0.4）方面无显著差异。术前，移植组的第一秒用力呼气容积百分比（FEV1%）（23.6±8.5 vs. 31.9±17.7，p = 0.008）显著更低。术后一年，移植患者的mBODE改善更为显著（-5.7 vs. -2.0，p = 0.0004）、FEV1%（43.4 vs. 2.2%，p = 0.0004）和Borg评分（-3.0 vs. -1.4，p = 0.04）。与LVRS患者相比，移植患者的长期生存率更低（p = 0.01）。影响生存的唯一变量是手术类型，LVRS更具优势（风险比1.7，95%置信区间1.05 - 2.77）。在移植后平均随访2.4±2.5年和LVRS后平均随访5.0±3.1年期间，移植组的平均总成本更高（381,732美元 vs. 140,637美元，p < 0.0001）。移植患者住院时间更长（74.3±81.3天 vs. 39.5±66.7天，p = 0.009），门诊就诊次数更多（29.9±28.8次 vs. 12.3±12.6次，p < 0.0001）。在存活超过1年的患者中，移植可提供更高的功能状态水平，在气流阻塞、呼吸困难、运动耐量和mBODE评分方面有更大改善，但成本更高且死亡率更高。
