Hutter J A, Stewart S, Higenbottam T, Scott J P, Wallwork J
Department of Surgery, Papworth Hospital, Cambridge, England.
J Heart Transplant. 1988 Nov-Dec;7(6):440-4.
In our experience a lung biopsy specimen taken by means of a fiberoptic bronchoscope is a useful, safe technique for the diagnosis of rejection in heart-lung transplant recipients. To determine that the histologic features associated with rejection can be identified in transbronchial biopsy specimens, 35 biopsy specimens (group A) taken when retrospective review confirmed a clinical diagnosis of rejection without evidence of infection were identified from a total of 107 biopsy specimens. These were compared with 14 biopsy specimens (group B) taken when the patients were well. Several foci of dense perivascular mononuclear cell infiltration with pyroninophilic lymphocytes and plasma cells were seen in 79% of group A biopsy specimens. Fewer foci of non-pyroninophilic cells were seen in group B biopsy specimens (p = 0.005). There was also a difference in the histologic features of the mucosa and interstitial lung tissue. We believe that the early confirmation of rejection followed by adequate augmentation of immunosuppression may prove to be an important factor in reducing the incidence of obliterative bronchiolitis in heart-lung transplant recipients.
根据我们的经验，通过纤维支气管镜获取肺活检标本是诊断心肺移植受者排斥反应的一种有用且安全的技术。为了确定经支气管活检标本中能够识别出与排斥反应相关的组织学特征，我们从总共107份活检标本中，找出了35份活检标本（A组），这些标本是在回顾性分析确认临床诊断为排斥反应且无感染证据时获取的。将这些标本与14份患者病情稳定时获取的活检标本（B组）进行比较。在A组79%的活检标本中可见多个伴有嗜派洛宁淋巴细胞和浆细胞的密集血管周围单核细胞浸润灶。B组活检标本中可见的非嗜派洛宁细胞灶较少（p = 0.005）。黏膜和肺间质组织的组织学特征也存在差异。我们认为，早期确诊排斥反应并适当加强免疫抑制可能是降低心肺移植受者闭塞性细支气管炎发生率的一个重要因素。
