Ikonen T, Harjula A L, Kinnula V L, Savola J, Sovijärvi A
Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
J Heart Lung Transplant. 1995 Mar-Apr;14(2):244-50.
Staging of bronchiolitis obliterans syndrome is based on the decline of forced expiratory volume in 1 second, a measure of overall ventilatory capacity. A single staging system is applied to all lung recipients, regardless of the bias which can be caused by the native lung after single lung transplantation.
We determined the decline of graft function in single lung recipients by a combination of two methods: 133-Xe radiospirometry and dynamic spirometry. The forced expiratory volume in 1 second fraction of the transplant (FEV1tx) was calculated from the proportion of ventilation of the transplant (Vtx) and forced expiratory volume in 1 second. Eight single lung recipients were followed up for a median observation period of 17 months; bronchiolitis obliterans syndrome developed in four of them.
The fractional decline of forced expiratory volume in 1 second of the transplant was significantly greater than the decline of forced expiratory volume in 1 second (p = 0.016) in all patients during the follow-up. In the patients with bronchiolitis obliterans syndrome, the mean decline in forced expiratory volume in 1 second was 1.1 L (39.5%), and in forced expiratory volume in 1 second of the transplant it was 0.9 L (55.8%). The measurement of forced expiratory volume in 1 second of the transplant suggested stage 2a and 3a dysfunction in two grafts in which the assessment of forced expiratory volume in 1 second indicated stage 1a bronchiolitis obliterans syndrome. In one patient, decrease of forced expiratory volume in 1 second of the transplant was suggestive of chronic dysfunction 4 months before it was diagnosed by biopsy and declined lung function.
The assessment of forced expiratory volume in 1 second seems to underestimate the severity of chronic dysfunction in single lung grafts. Instead, the determination of forced expiratory volume in 1 second of the transplant with radioactive tracers provides selective information of the graft function, which could be used for clinical evaluation of bronchiolitis obliterans syndrome in single lung recipients.
闭塞性细支气管炎综合征的分期基于第一秒用力呼气量的下降，这是一种衡量整体通气能力的指标。单一的分期系统应用于所有肺移植受者，而不考虑单肺移植后自身肺可能导致的偏差。
我们通过133 - Xe放射性肺通气测定法和动态肺量测定法相结合的方式，确定单肺移植受者移植肺功能的下降情况。移植肺第一秒用力呼气量分数（FEV1tx）由移植肺通气量（Vtx）与第一秒用力呼气量的比例计算得出。对8名单肺移植受者进行了为期17个月的中位观察期随访；其中4人发生了闭塞性细支气管炎综合征。
在随访期间，所有患者移植肺第一秒用力呼气量分数的下降幅度显著大于第一秒用力呼气量的下降幅度（p = 0.016）。在患有闭塞性细支气管炎综合征的患者中，第一秒用力呼气量平均下降1.1 L（39.5%），移植肺第一秒用力呼气量平均下降0.9 L（55.8%）。移植肺第一秒用力呼气量的测量显示，在两例移植肺中存在2a期和3a期功能障碍，而第一秒用力呼气量评估显示为1a期闭塞性细支气管炎综合征。在一名患者中，移植肺第一秒用力呼气量下降提示慢性功能障碍，比活检诊断及肺功能下降早4个月。
第一秒用力呼气量的评估似乎低估了单肺移植慢性功能障碍的严重程度。相反，用放射性示踪剂测定移植肺第一秒用力呼气量可提供移植肺功能的选择性信息，可用于单肺移植受者闭塞性细支气管炎综合征的临床评估。
