Starnes V A, Theodore J, Oyer P E, Stinson E B, Moreno-Cabral C E, Sibley R, Barry G, Shumway N E
Department of Cardiovascular Surgery, Stanford University School of Medicine, Calif.
J Thorac Cardiovasc Surg. 1989 Nov;98(5 Pt 2):945-50.
Since January 1988, prospective serial transbronchial lung biopsies have been performed as a diagnostic procedure to facilitate the care of recipients of heart-lung transplants. Eighty-five cardiac and 70 transbronchial lung biopsies have been prospectively performed in 10 patients beginning within the first week of transplantation. Forty-eight percent (34/70) of the transbronchial lung biopsies and 16.5% (14/85) of the heart biopsies were positive for either rejection or infection. Pulmonary rejection was evident by a perivascular lymphocytic infiltrate that cleared with pulse steroid therapy. Pulmonary and cardiac rejection were present synchronously on six occasions and asynchronously on 16 occasions (nine pulmonary and seven cardiac). Four patients had early cytomegalovirus pneumonitis on biopsy specimen and were successfully treated with ganciclovir. Of the 40 clinically indicated biopsies, 29 (72.5%) were positive for rejection or infection and guided subsequent therapy. In summary, transbronchial lung biopsies have provided prompt (within 24 hours) serial diagnostic information that has guided successful treatment of infection (cytomegalovirus, aspergillosis, and Pneumocystis) and rejection. Asynchronous rejection of the heart and lungs has been conclusively demonstrated. With the early detection of rejection and infection, we are optimistic that chronic airway disease in patients with a heart-lung transplant may be reduced.
自1988年1月起，前瞻性系列经支气管肺活检已作为一种诊断程序开展，以促进心肺移植受者的护理。从移植第一周开始，已对10例患者前瞻性地进行了85次心脏活检和70次经支气管肺活检。经支气管肺活检中有48%（34/70）、心脏活检中有16.5%（14/85）的活检结果显示存在排斥反应或感染。肺排斥反应表现为血管周围淋巴细胞浸润，经脉冲类固醇治疗后消退。肺和心脏排斥反应同时出现6次，不同时出现16次（9次肺部排斥和7次心脏排斥）。4例患者活检标本显示早期巨细胞病毒性肺炎，经更昔洛韦治疗成功。在40次临床指征性活检中，29次（72.5%）的活检结果显示存在排斥反应或感染，并指导了后续治疗。总之，经支气管肺活检提供了快速（24小时内）的系列诊断信息，指导了感染（巨细胞病毒、曲霉病和肺孢子菌）和排斥反应的成功治疗。已确凿证实心脏和肺部存在不同时发生的排斥反应。随着排斥反应和感染的早期发现，我们乐观地认为心肺移植患者的慢性气道疾病可能会减少。
