Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA 22042, United States.
Respir Med. 2009 Dec;103(12):1816-21. doi: 10.1016/j.rmed.2009.07.011. Epub 2009 Aug 13.
Bronchiolitis Obliterans Syndrome (BOS) complicates the course of many lung transplant recipients. It carries significant risk of morbidity and mortality, but its course is difficult to characterize. We evaluated the prognostic utility of the 6min walk test (6MWT) obtained after the onset of BOS in 42 patients. This was compared to the prognostic significance of changes in the FEV(1). The median time between the onset of BOS and the 6MWT was 109 days. The median decline in the FEV(1) from baseline to BOS onset was 25.7%, while the median change over the ensuing 3 months was 12.5%. Neither of these was predictive of subsequent mortality. The 6MWT yielded averages in the resting saturation, lowest saturation, distance walked and maximal Borg scores of 97%, 90.2%, 323m and 2.35, respectively. The best of these parameters in discriminating survival was the distance. Patients who walked further than 330m had a median survival of 1178 days versus 263 days for those who walked less (p<0.0001). We conclude that the 6MWT provides important prognostic information in patients with BOS and might perform better than spirometry. Use of this test might allow different clinical phenotypes to be discerned.
闭塞性细支气管炎综合征（BOS）使许多肺移植受者的病情复杂化。它有很高的发病率和死亡率风险，但病程难以确定。我们评估了 42 例 BOS 发病后 6 分钟步行试验（6MWT）的预后价值，并与 FEV1 的变化的预后意义进行了比较。BOS 发病和 6MWT 之间的中位时间为 109 天。从基线到 BOS 发病时 FEV1 的中位下降为 25.7%，而随后 3 个月的中位变化为 12.5%。这些都不能预测随后的死亡率。6MWT 的静息饱和度、最低饱和度、行走距离和最大 Borg 评分平均值分别为 97%、90.2%、323m 和 2.35。这些参数中，区分生存的最佳参数是距离。行走距离超过 330m 的患者中位生存期为 1178 天，而行走距离小于 330m 的患者为 263 天（p<0.0001）。我们得出结论，6MWT 为 BOS 患者提供了重要的预后信息，其性能可能优于肺活量测定法。该测试的使用可能允许区分不同的临床表型。
