Davidsen Jesper Rømhild, Laursen Christian B, Højlund Mikkel, Lund Thomas Kromann, Jeschke Klaus Nielsen, Iversen Martin, Kalhauge Anna, Bendstrup Elisabeth, Carlsen Jørn, Perch Michael, Henriksen Daniel Pilsgaard, Schultz Hans Henrik Lawaetz
South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, 5000 Odense, Denmark.
Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark.
J Clin Med. 2021 Mar 5;10(5):1078. doi: 10.3390/jcm10051078.
Bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS) are two distinct phenotypes of chronic lung allograft dysfunction (CLAD) in lung transplant (LTx) recipients. Contrary to BOS, RAS can radiologically present with a pleuroparenchymal fibroelastosis (PPFE) pattern. This study investigates lung ultrasound (LUS) to identify potential surrogate markers of PPFE in order to distinguish CLAD phenotype RAS from BOS.
A prospective cohort study performed at a National Lung Transplantation Center during June 2016 to December 2017. Patients were examined with LUS and high-resolution computed tomography of the thorax (HRCT).
Twenty-five CLAD patients (72% males, median age of 54 years) were included, corresponding to 19/6 BOS/RAS patients. LUS-identified pleural thickening was more pronounced in RAS vs. BOS patients (5.6 vs. 2.9 mm) compatible with PPFE on HRCT. LUS-identified pleural thickening as an indicator of PPFE in RAS patients' upper lobes showed a sensitivity of 100% (95% CI; 54-100%), specificity of 100% (95% CI; 82-100%), PPV of 100% (95% CI; 54-100%), and NPV of 100% (95% CI; 82-100%).
Apical pleural thickening detected by LUS and compatible with PPFE on HRCT separates RAS from BOS in patients with CLAD. We propose LUS as a supplementary tool for initial CLAD phenotyping.
闭塞性细支气管炎综合征（BOS）和限制性移植肺综合征（RAS）是肺移植（LTx）受者慢性移植肺功能障碍（CLAD）的两种不同表型。与BOS不同，RAS在放射学上可表现为胸膜实质纤维弹性组织增生（PPFE）模式。本研究调查肺超声（LUS）以识别PPFE的潜在替代标志物，以便将CLAD表型RAS与BOS区分开来。
2016年6月至2017年12月在一家国家肺移植中心进行了一项前瞻性队列研究。对患者进行了LUS和胸部高分辨率计算机断层扫描（HRCT）检查。
纳入了25例CLAD患者（72%为男性，中位年龄54岁），其中19例为BOS患者，6例为RAS患者。LUS识别出的胸膜增厚在RAS患者中比BOS患者更明显（5.6 vs. 2.9 mm），与HRCT上的PPFE相符。LUS识别出的胸膜增厚作为RAS患者上叶PPFE的指标，敏感性为100%（95%CI；54 - 100%），特异性为100%（95%CI；82 - 100%），阳性预测值为100%（95%CI；54 - 100%），阴性预测值为100%（95%CI；82 - 100%）。
LUS检测到的与HRCT上的PPFE相符的尖部胸膜增厚可将CLAD患者中的RAS与BOS区分开来。我们建议将LUS作为CLAD初始表型分析的辅助工具。
