肾移植患者肺部疾病行开胸肺活检的诊断率及并发症
The diagnostic yield and complications of open lung biopsies in kidney transplant patients with pulmonary disease.
作者信息
Tomotani Daniere Yurie Vieira, Bafi Antônio Tonete, Pacheco Eduardo Souza, de Sandes-Freitas Tainá Veras, Viana Laila Almeida, de Oliveira Pontes Edgar Porto, Tamura Nikkei, Tedesco-Silva Hélio, Machado Flavia Ribeiro, Freitas Flávio Geraldo Rezende
机构信息
Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil;; Hospital do Rim, Nephrology Division, São Paulo, SP, Brazil.
Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil.
出版信息
J Thorac Dis. 2017 Jan;9(1):166-175. doi: 10.21037/jtd.2017.01.09.
BACKGROUND
The purpose of this study was to assess the efficacy of open lung biopsy (OLB) in determining the specific diagnosis and the related complications in patients with undiagnosed diffuse pulmonary infiltrates.
METHODS
This single center, retrospective study included adult kidney transplant patients who underwent OLB. The patients had diffuse pulmonary infiltrates without definitive diagnoses and failed to respond to empiric antibiotic treatment. We analyzed the number of specific diagnoses, changes in treatment and the occurrence of complications in these patients. A logistic regression was used to determine which variables were predictors of hospital mortality.
RESULTS
From April 2010 to April 2014, 87 patients consecutively underwent OLB. A specific diagnosis was reached in 74 (85.1%) patients. In 46 patients (53%), their therapeutic management was changed after the OLB results. Twenty-five (28.7%) patients had complications related to the OLB. The hospital mortality rate was 25.2%. Age, SAPS3 score and complications related to the procedure were independent predictors of all-cause mortality.
CONCLUSIONS
OLB is a high-risk procedure with a high diagnostic yield in kidney transplant patients with diffuse pulmonary infiltrates who did not have a definitive diagnosis and who failed to respond to empiric antibiotic treatment. Complications related to OLB were common and were independently associated with intra-hospital mortality.
背景
本研究旨在评估开放性肺活检（OLB）在明确诊断不明的弥漫性肺浸润患者的具体诊断及相关并发症方面的疗效。
方法
这项单中心回顾性研究纳入了接受OLB的成年肾移植患者。这些患者有弥漫性肺浸润但未确诊，且对经验性抗生素治疗无反应。我们分析了这些患者的具体诊断数量、治疗变化及并发症的发生情况。采用逻辑回归分析来确定哪些变量是医院死亡率的预测因素。
结果
2010年4月至2014年4月，87例患者连续接受了OLB。74例（85.1%）患者获得了明确诊断。46例（53%）患者在OLB结果出来后治疗方案发生了改变。25例（28.7%）患者出现了与OLB相关的并发症。医院死亡率为25.2%。年龄、SAPS3评分及与手术相关的并发症是全因死亡率的独立预测因素。
结论
对于诊断不明且对经验性抗生素治疗无反应的弥漫性肺浸润肾移植患者，OLB是一种诊断率高但风险也高的手术。与OLB相关的并发症很常见，且与院内死亡率独立相关。
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