Nakamae Mika, Yamashita Mariko, Koh Hideo, Nishimoto Mitsutaka, Hayashi Yoshiki, Nakane Takahiko, Nakashima Yasuhiro, Hirose Asao, Hino Masayuki, Nakamae Hirohisa
Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
Department of Clinical Laboratory, Osaka City University Hospital, Osaka, Japan.
Transpl Int. 2016 Jun;29(6):707-14. doi: 10.1111/tri.12779. Epub 2016 May 2.
Some studies on the predictive value of determining pulmonary function prior to allogeneic hematopoietic cell transplantation (allo-HCT) have shown a significant association between pulmonary function test (PFT) parameters and pulmonary complications, and mortality. However, the percentage of patients showing abnormalities in pretransplant PFT parameters is low. We comprehensively evaluated the effect of pretransplant PFT parameters, including a marker of small airway disease (ratio of the airflow rate of 50% vital capacity to the airflow rate of 25% vital capacity (V˙50/V˙25), on outcomes in 206 evaluable patients who underwent allo-HCT at our institute. Notable among the significant parameters in a univariable analysis, V˙50/V˙25 was the most powerful indicator of survival following allo-HCT (delta-Akaike information criterion [∆AIC] = 12.47, ∆χ(2) = 14.47; P = 0.0001). Additionally, a pretransplant lung function score (pLFS) established by applying three parameters with superior predictive values including V˙50/V˙25 represented a better discriminating variable for the prediction of survival. Our data demonstrate that a pLFS incorporating a parameter of small airway disease, rather than the parameters of central airway obstruction, may be useful for predicting patient survival following allo-HCT.
一些关于异基因造血细胞移植（allo-HCT）前测定肺功能预测价值的研究表明，肺功能测试（PFT）参数与肺部并发症及死亡率之间存在显著关联。然而，移植前PFT参数异常的患者比例较低。我们对206例在我院接受allo-HCT的可评估患者，全面评估了移植前PFT参数的影响，这些参数包括小气道疾病标志物（肺活量50%时的气流速率与肺活量25%时的气流速率之比（V˙50/V˙25））对预后的影响。在单变量分析的显著参数中，V˙50/V˙25是allo-HCT后生存的最有力指标（赤池信息准则增量[∆AIC]=12.47，∆χ(2)=14.47；P=0.0001）。此外，通过应用包括V˙50/V˙25在内的三个具有较高预测价值的参数建立的移植前肺功能评分（pLFS），在预测生存方面是一个更好的判别变量。我们的数据表明，纳入小气道疾病参数而非中央气道阻塞参数的pLFS，可能有助于预测allo-HCT后患者的生存情况。
