Robinson Paul D, Spencer Helen, Aurora Paul
Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Department of Cardiothoracic Transplantation, Great Ormond Street Hospital for Children NHS Trust, London, UK; Discipline of Pediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Department of Cardiothoracic Transplantation, Great Ormond Street Hospital for Children NHS Trust, London, UK.
J Heart Lung Transplant. 2015 Aug;34(8):1082-8. doi: 10.1016/j.healun.2015.03.010. Epub 2015 Mar 26.
The diagnostic criteria for bronchiolitis obliterans syndrome (BOS) are predominantly adult-focused. The relationship between application and impact of reference equation choice on pediatric baseline lung function achieved and subsequent BOS diagnosis remains unclear.
Lung function spirometry data (FEV(1), FVC and FEF(25-75)) from pediatric subjects transplanted at the Great Ormond Street Hospital over a 10-year period were collated. Baseline values achieved after lung transplantation and BOS rates were examined. Raw values were compared with 2 different reference equations (the "Brompton" and modern collated "All-age" equations). The impact of FEF(25-75) baseline definition was investigated.
Fifty subjects were included, 17 males and 33 females, transplanted at a median (range) age of 14.0 years (3.2 to 17.3 years, 83% >10 years old), and followed for 1,028 (388 to 2,613) days post-transplantation. Raw values underestimated baseline lung function attainment for all indices. Magnitude of baseline lung function was affected by reference equation choice. Mean FEV(1) values were: Brompton 97.9% (SD 20.3%) and All-age 86.3% (SD 15.4%) of predicted (p < 0.0001). BOS 0p incidence was significantly higher for All-age predicted than for raw values (64% and 40%, respectively, p = 0.027). Modification of FEF(25-75) baseline (to either FEV(1) or FVC baseline) led to a reduction in BOS 0p detection (p < 0.01).
Modern collated reference equations should be used for lung function monitoring in pediatric subjects after lung transplantation. Standardization of FEF(25-75) baseline definition is urgently required. These data question the utility of the FEF(25-75) criterion as an early marker of BOS 0p in pediatric subjects.
闭塞性细支气管炎综合征（BOS）的诊断标准主要以成人为重点。参考方程选择的应用与对儿童达到的基线肺功能及后续BOS诊断的影响之间的关系仍不明确。
整理了在大奥蒙德街医院接受移植的儿童受试者在10年期间的肺功能肺活量测定数据（FEV(1)、FVC和FEF(25 - 75)）。检查了肺移植后的基线值和BOS发生率。将原始值与2种不同的参考方程（“布朗普顿”方程和现代整理的“全年龄”方程）进行比较。研究了FEF(25 - 75)基线定义的影响。
纳入50名受试者，17名男性和33名女性，移植时的中位（范围）年龄为14.0岁（3.2至17.3岁，83%大于10岁），移植后随访1028天（388至2613天）。原始值低估了所有指标的基线肺功能达到情况。基线肺功能的大小受参考方程选择的影响。平均FEV(1)值分别为：布朗普顿方程预测值的97.9%（标准差20.3%）和全年龄方程预测值的86.3%（标准差15.4%）（p < 0.0001）。全年龄方程预测的BOS 0p发生率显著高于原始值（分别为64%和40%，p = 0.027）。将FEF(25 - 75)基线修改为FEV(1)或FVC基线会导致BOS 0p检测率降低（p < 0.01）。
肺移植后的儿童受试者肺功能监测应使用现代整理的参考方程。迫切需要对FEF(25 - 75)基线定义进行标准化。这些数据质疑了FEF(25 - 75)标准作为儿童BOS 0p早期标志物的效用。
