Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
Division of Gastroenterology, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
Liver Transpl. 2020 Aug;26(8):989-999. doi: 10.1002/lt.25794. Epub 2020 Jul 9.
We investigated the prevalence of spirometric restriction in liver transplantation (LT) candidates and the clinical impacts of restriction. We performed a cross-sectional study within the Pulmonary Vascular Complications of Liver Disease 2 (PVCLD2) study, a multicenter prospective cohort study of patients being evaluated for LT. Patients with obstructive lung disease or missing spirometry or chest imaging were excluded. Patients with and without restriction, defined as a forced vital capacity (FVC) <70% predicted, were compared. Restriction prevalence was 18.4% (63/343). Higher Model for End-Stage Liver Disease-sodium score (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.11; P = 0.007), the presence of pleural effusions (OR, 3.59; 95% CI, 1.96-6.58; P < 0.001), and a history of ascites (OR, 2.59; 95% CI, 1.26-5.33; P = 0.01) were associated with the presence of restriction, though one-third with restriction had neither pleural effusions nor ascites. In multivariate analysis, restriction was significantly and independently associated with lower 6-minute walk distances (least squares mean, 342.0 [95% CI, 316.6-367.4] m versus 395.7 [95% CI, 381.2-410.2] m; P < 0.001), dyspnea (OR, 2.69; 95% CI, 1.46-4.95; P = 0.002), and lower physical component summary Short Form 36 scores indicating worse quality of life (least squares mean, 34.1 [95% CI, 31.5-36.7] versus 38.2 [95% CI, 36.6-39.7]; P = 0.004). Lower FVC percent predicted was associated with an increased risk of death (hazard ratio, 1.16; 95% CI, 1.04-1.27 per 10-point decrease in FVC percent predicted; P = 0.01). Restriction and abnormal lung function are common in LT candidates; can be present in the absence of an obvious cause, such as pleural effusions or ascites; and is associated with worse exercise capacity, quality of life, and survival.
我们研究了在肝移植（LT）候选者中肺通气功能受限的流行情况以及限制的临床影响。我们在多中心前瞻性队列研究肺血管并发症肝病 2 号（PVCLD2）研究中进行了一项横断面研究，该研究评估了 LT 的患者。排除了患有阻塞性肺疾病或缺少肺量测定或胸部影像学的患者。将受限患者（定义为用力肺活量（FVC）<70%预测值）与非受限患者进行比较。受限的患病率为 18.4%（63/343）。较高的终末期肝病模型钠评分（比值比[OR]，1.06；95%置信区间[CI]，1.02-1.11；P=0.007），胸腔积液（OR，3.59；95%CI，1.96-6.58；P<0.001）和腹水的存在（OR，2.59；95%CI，1.26-5.33；P=0.01）与限制的存在相关，尽管三分之一的限制患者既没有胸腔积液也没有腹水。在多变量分析中，限制与 6 分钟步行距离明显独立相关（最小二乘均值，342.0[95%CI，316.6-367.4]m与 395.7[95%CI，381.2-410.2]m；P<0.001），呼吸困难（OR，2.69；95%CI，1.46-4.95；P=0.002）和较差的物理成分综合 36 项简短形式健康调查评分表明生活质量较差（最小二乘均值，34.1[95%CI，31.5-36.7]与 38.2[95%CI，36.6-39.7]；P=0.004）。用力肺活量预测百分比的降低与死亡风险增加相关（风险比，1.16；95%CI，每降低 10%用力肺活量预测百分比增加 1.04-1.27；P=0.01）。在 LT 候选者中，限制和异常肺功能很常见；可以在没有明显原因的情况下出现，例如胸腔积液或腹水；并且与较差的运动能力、生活质量和生存有关。
