Takao M, Katayama Y, Onoda K, Tanabe H, Hiraiwa T, Mizutani T, Yada I, Namikawa S, Yuasa H, Kusagawa M
Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Japan.
J Heart Lung Transplant. 1991 Nov-Dec;10(6):956-66; discussion 967.
Bronchial mucosal blood flow (BMBF) was measured with a laser-Doppler flowmeter in a canine model (n = 20), and the measurement was evaluated to see if it was a useful method for diagnosing allografted lung rejection. The ratio of the value of BMBF at the level of the donor second carina against that at the level of carina (the L/C ratio, an index of BMBF of donor bronchus) decreased in accordance with the extent of lung rejection, and it increased and entered the normal range with the reversal of lung rejection. Compared with the L/C ratio and the rejection grade by histologic changes in open-lung biopsy, the L/C ratio at grade 0 (latent phase) was 0.91 +/- 0.07; at grade Ia (early vascular phase), 0.86 +/- 0.05; at grade Ib (late vascular phase), 0.68 +/- 0.10; at grade II (early alveolar phase), 0.60 +/- 0.14; and at grade III (late alveolar phase), 0.50 +/- 0.15. A significant difference was noted between grades Ia and Ib (p less than 0.01) and between grades Ib and III (p less than 0.01). The sensitivity and the specificity in the detection of early rejection before grade Ib were 96% and 92%, with only one false-negative and two false-positives resulting from 51 measurements of BMBF. In three cases of serious lung infections, the L/C ratio did not fall, and the rejection could be distinguished from infection. These results suggest that measurement of the BMBF is useful for detecting the early rejection of transplanted lungs.
采用激光多普勒血流仪在犬模型（n = 20）中测量支气管黏膜血流（BMBF），并对该测量方法进行评估，以确定其是否为诊断同种异体肺排斥反应的有效方法。供体第二隆突水平的BMBF值与隆突水平的BMBF值之比（L/C比值，供体支气管BMBF的一个指标）随着肺排斥反应程度的增加而降低，随着肺排斥反应的逆转而升高并进入正常范围。与开放肺活检组织学变化的L/C比值和排斥反应分级相比，0级（潜伏期）的L/C比值为0.91±0.07；Ia级（早期血管期）为0.86±0.05；Ib级（晚期血管期）为0.68±0.10；II级（早期肺泡期）为0.60±0.14；III级（晚期肺泡期）为0.50±0.15。Ia级和Ib级之间（p<0.01）以及Ib级和III级之间（p<0.01）存在显著差异。在Ib级之前检测早期排斥反应的敏感性和特异性分别为96%和92%，51次BMBF测量仅产生1例假阴性和2例假阳性。在3例严重肺部感染病例中，L/C比值未下降，可将排斥反应与感染区分开来。这些结果表明，测量BMBF有助于检测移植肺的早期排斥反应。
