Respiratory Division, University Hospitals Leuven; Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
Respiratory Division, University Hospitals Leuven; Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
J Heart Lung Transplant. 2014 May;33(5):492-8. doi: 10.1016/j.healun.2014.01.857. Epub 2014 Jan 24.
Acute cellular rejection (AR) after lung transplantation may result in significant morbidity and mortality both on the short and long term. Transbronchial biopsy through flexible bronchoscopy is highly sensitive for the diagnosis of AR, but reproducibility of histopathologic interpretation is less convincing. Probe-based confocal laser endomicroscopy (pCLE), a novel imaging tool in the field of respiratory medicine, enables real-time imaging of the pulmonary acini.
We performed 105 bronchoscopies in lung transplant recipients, combining both transbronchial biopsies and pCLE. We conducted an observational survey for pCLE findings in AR.
Calculations for cellularity showed a median cell count (ACA) of 50 (IQR 18 to 120) cells per microscopic field for AR and 10 (IQR 0 to 15) cells per microscopic field for matched controls (p = 0.0004). Cellular autofluorescence in the AR group was 1,163 (± 157) units and 489 (± 101) units for the matched controls (p = 0.0009). Autofluorescent cells were present in 73% (± 10) of the recorded frames in the AR group and in only 42% (± 9) of the recorded frames in the control group (p = 0.03). Contingency analysis for the presence/absence of ACA in the AR group versus the control group showed a sensitivity of 0.93 and a specificity of 0.46 (relative risk = 6.5 [95% CI 0.94 to 44.8], p = 0.01). The consecutive application of 3 pCLE criteria resulted in a sensitivity of 0.93 and a specificity of 0.83 for detection of AR.
Our observational survey suggests the existence of specific pCLE characteristics in patients with AR. Further efforts are necessary to validate these findings prospectively.
肺移植后急性细胞排斥（AR）可导致短期和长期的高发病率和死亡率。经支气管镜活检对 AR 的诊断具有高度敏感性，但组织病理学解释的可重复性不太令人信服。基于探针的共聚焦激光内窥镜检查（pCLE）是呼吸医学领域的一种新型成像工具，可实时成像肺部腺泡。
我们对肺移植受者进行了 105 次支气管镜检查，结合经支气管活检和 pCLE。我们对 AR 的 pCLE 结果进行了观察性调查。
细胞计数的计算显示 AR 的每个显微镜视野的细胞计数中位数（ACA）为 50（IQR 18 至 120）个细胞，而匹配对照的每个显微镜视野的细胞计数中位数为 10（IQR 0 至 15）个细胞（p = 0.0004）。AR 组的细胞自体荧光为 1163（±157）单位，匹配对照组为 489（±101）单位（p = 0.0009）。AR 组记录的帧中存在自体荧光细胞的比例为 73%（±10），而对照组为 42%（±9）（p = 0.03）。AR 组与对照组中存在/不存在 ACA 的一致性分析显示，敏感性为 0.93，特异性为 0.46（相对风险=6.5[95%CI 0.94 至 44.8]，p = 0.01）。连续应用 3 个 pCLE 标准可检测 AR 的敏感性为 0.93，特异性为 0.83。
我们的观察性调查表明，AR 患者存在特定的 pCLE 特征。需要进一步努力前瞻性验证这些发现。
