Park Joo Hun, Kim Dong Kwan, Kim Dong Soon, Koh Younsuck, Lee Sang-Do, Kim Woo Sung, Kim Won Dong, Park Seung Il
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-600, Republic of Korea.
Eur J Cardiothorac Surg. 2007 Jun;31(6):1115-9. doi: 10.1016/j.ejcts.2007.02.035. Epub 2007 Apr 5.
The overall safety of surgical lung biopsy in patients with idiopathic interstitial pneumonia (IIP) remains controversial. This study was performed to investigate the mortality and complication rate and identify the risk factors for surgical lung biopsy in patients with IIP.
A total of 200 patients with IIP who underwent surgical lung biopsy at the Asan Medical Center, Korea, from April 1990 to August 2003, were enrolled. Complications and mortality were analyzed retrospectively.
(1) The mortality rate 30 days after the surgical lung biopsy was 4.3%, which was significantly higher than the control group. Biopsy performed at the time of acute exacerbation (AE) resulted in higher 30-day mortality (28.6%) compared to non-AE (3.0%; p<0.05). AE was followed by biopsy itself in three cases. (2) Univariate analysis indicated that lower FVC, lower DL(CO), and presence of AE were significant risk factors for 30-day mortality (p<0.05). However, multivariate analysis revealed that only AE (OR: 11.334, 95% CI: 1.727-74.365, p=0.011) was an independent risk factor. (3) The patients with low DL(CO) (<50% predicted) had higher mortality and complication rate than high DL(CO) group.
Our data suggested that the presence of acute exacerbation at the time of biopsy and lower DL(CO) were predictors of higher mortality after the surgical lung biopsy.
特发性间质性肺炎（IIP）患者手术肺活检的总体安全性仍存在争议。本研究旨在调查IIP患者手术肺活检的死亡率和并发症发生率，并确定相关危险因素。
纳入1990年4月至2003年8月在韩国峨山医学中心接受手术肺活检的200例IIP患者。对并发症和死亡率进行回顾性分析。
（1）手术肺活检后30天的死亡率为4.3%，显著高于对照组。与非急性加重期（AE）（3.0%；p<0.05）相比，在急性加重期（AE）进行活检导致30天死亡率更高（28.6%）。有3例患者在AE后进行了活检。（2）单因素分析表明，较低的用力肺活量（FVC）、较低的一氧化碳弥散量（DL(CO)）和AE的存在是30天死亡率的显著危险因素（p<0.05）。然而，多因素分析显示只有AE（比值比：11.334，95%置信区间：1.727-74.365，p=0.011）是独立危险因素。（3）DL(CO)较低（<预测值的50%）的患者比DL(CO)较高的组死亡率和并发症发生率更高。
我们的数据表明，活检时存在急性加重和较低的DL(CO)是手术肺活检后死亡率较高的预测因素。
