Cincinnati VA Medical Center, University of Cincinnati Medical Center, Cincinnati, OH.
St. Louis Pathology Associates, Department of Pathology, Mercy Medical, St. Louis, MO.
Transplantation. 2019 May;103(5):1036-1042. doi: 10.1097/TP.0000000000002430.
This study was designed to identify factors associated with clinical response to extracorporeal photopheresis (ECP) and mortality after ECP in lung allograft recipients with bronchiolitis obliterans.
Forced expiratory volume in 1 second (FEV1) values obtained 6 months before (baseline) and 6 months after initiation of ECP were used to plot the linear relationship between FEV1 versus time before and after ECP. Response to ECP was assigned when a positive integer was derived after subtracting the baseline rate of decline from the rate of decline 6 months after ECP. Univariate and multivariate logistic regression analyses were used to identify demographic, treatment-related factors or spirometric parameters that may be associated with response to ECP or mortality at either 6 or 16 months after initiation of ECP.
Forced expiratory volume in 1 second just before ECP was associated with mortality (P = 0.007) at 16 months after ECP initiation. An FEV1 of 1.50 L or less had a sensitivity of 87% and specificity of 60% to identify patients who died within 16 months after ECP initiation. Patients whose FEV1 decline exceeded 40 mL/month were 12 times more likely to have a response to ECP (P = 0.0001). Patients whose decline in FEV1 before ECP was statistically significant (P < 0.05) were nearly 10 times (P = 0.008) more likely to respond to ECP.
Forced expiratory volume in 1 second is an important predictor of mortality, and the response to ECP is influenced by both the extent (>40 mL/mo) and statistical significance of the relationship between FEV1 versus time before ECP initiation. Therefore, earlier bronchiolitis obliterans detection and more timely implementation of ECP (ie, when FEV1 values >1.5 L) should be considered especially in patients with a more aggressive rate of decline of lung function.
本研究旨在确定与肺移植受者闭塞性细支气管炎接受体外光化学疗法（ECP）后临床反应和死亡率相关的因素。
使用 ECP 前 6 个月（基线）和 ECP 后 6 个月获得的 1 秒用力呼气量（FEV1）值，绘制 FEV1 与 ECP 前后时间之间的线性关系。从 ECP 后 6 个月的下降率中减去基线下降率后得到一个正整数，将其分配为 ECP 的反应。使用单变量和多变量逻辑回归分析来确定人口统计学、治疗相关因素或肺量计参数，这些因素可能与 ECP 反应或 ECP 启动后 6 或 16 个月的死亡率相关。
在 ECP 启动后 16 个月，FEV1 在 ECP 前与死亡率相关（P = 0.007）。FEV1 为 1.50 L 或更低，其灵敏度为 87%，特异性为 60%，可识别 ECP 启动后 16 个月内死亡的患者。FEV1 下降超过 40 mL/月的患者对 ECP 有反应的可能性增加 12 倍（P = 0.0001）。FEV1 在 ECP 前呈统计学显著下降（P < 0.05）的患者对 ECP 有反应的可能性几乎增加 10 倍（P = 0.008）。
FEV1 是死亡率的重要预测指标，ECP 的反应受 FEV1 与 ECP 前时间之间的关系的程度（>40 mL/月）和统计学意义的影响。因此，应更早地检测闭塞性细支气管炎，并更及时地实施 ECP（即当 FEV1 值>1.5 L 时），特别是在肺功能下降率较高的患者中。
