晚期囊性纤维化患者的气管憩室：肺移植后的患病率、特征和结局。
Tracheal diverticula in advanced cystic fibrosis: Prevalence, features, and outcomes after lung transplantation.
机构信息
Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States.
Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States.
出版信息
J Cyst Fibros. 2017 Nov;16(6):735-743. doi: 10.1016/j.jcf.2017.07.015. Epub 2017 Jul 28.
BACKGROUND
Tracheal diverticula (TD) are rare anomalies that may harbor infected secretions, posing potential risk to patients with lung disease. In an end-stage cystic fibrosis (CF) cohort, we describe the characteristics and associated post-lung transplant (LTx) outcomes of TD.
METHODS
Pre-transplant computed tomography (CT)'s were reviewed in CF patients undergoing LTx. TD were characterized radiographically and on autopsy when available. Pre-transplant clinical variables and post-transplant outcomes were compared by TD status.
RESULTS
Of 93 patients, 35 (37.6%) had TD. 58% of TD had fat-stranding, and post-mortem TD examinations revealed histology carrying intense submucosal inflammation, and purulent contents that cultured identical species to sputum. There was no difference in post-LTx survival [HR 1.77 (0.82-3.82), p=0.147], bacterial re-colonization, or rejection in patients with TD compared to those without. Patients with TD were more likely to die from infection, but the result was not statistically significant [HR 2.02 (0.62-6.63), p=0.245].
CONCLUSIONS
We found a high prevalence of TD in end-stage CF, where diverticula may represent a large-airway bacterial reservoir. TD were not associated with differences in post-LTx outcomes, but given the infectious concerns further investigation is necessary.
背景
气管憩室（TD）是罕见的异常，可能藏有感染性分泌物，对患有肺部疾病的患者构成潜在风险。在终末期囊性纤维化（CF）患者队列中，我们描述了 TD 的特征及其与肺移植（LTx）后的相关结局。
方法
对接受 LTx 的 CF 患者的移植前计算机断层扫描（CT）进行了回顾。在有条件的情况下，通过影像学和尸检对 TD 进行了描述。通过 TD 状态比较了移植前的临床变量和移植后的结局。
结果
在 93 名患者中，有 35 名（37.6%）有 TD。58%的 TD 有脂肪条纹，尸检时的 TD 检查显示出强烈的黏膜下炎症和脓性内容物，培养的物种与痰液相同。与没有 TD 的患者相比，有 TD 的患者在 LTx 后的存活率[HR 1.77（0.82-3.82），p=0.147]、细菌再定植或排斥反应没有差异。有 TD 的患者更有可能因感染而死亡，但结果没有统计学意义[HR 2.02（0.62-6.63），p=0.245]。
结论
我们发现终末期 CF 中 TD 的患病率很高，其中憩室可能代表一个大气道的细菌储存库。TD 与 LTx 后的结局没有差异，但鉴于感染的担忧，需要进一步调查。
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