Herve P, Silbert D, Cerrina J, Simonneau G, Dartevelle P
Hôpital Marie-Lannelongue, Le Plessis Robinson, Clamart, France.
Chest. 1993 Jan;103(1):59-63. doi: 10.1378/chest.103.1.59.
The study objective was to investigate bronchial mucociliary clearance after heart/lung and double lung transplantation. Bronchial mucociliary clearance was measured using a noninvasive radioaerosol technique: 99mTc-labeled albumin was aerosolized using a spinning-top generator (mass median aerodynamic diameter, 7.5 mu; geometric standard deviation, 1.5 mu). Radioactivity counts were acquired during 60 min with a gamma camera. A region of interest was drawn over the right lung delineated by a 133Xe lung ventilation image. Bronchial mucociliary clearance was assessed as the percentage of decrease in radioactivity per hour calculated on time-activity curves fitted by a monoexponential model. To exclude patients with acute lung rejection, opportunistic lung infection, and obliterative bronchiolitis, all patients with transplants underwent pulmonary function tests and bronchoscopic examination before clearance measurement. Eight heart/lung and five double-lung nonsmoking transplant patients with normal lung histology were studied 19.3 +/- 4.0 mo after surgery and compared to nine normal nonsmokers. A similar proximal deposition of the aerosol was obtained in patients with transplants and normal subjects; skew values of distribution histograms of aerosol radioactivity counts were 2.1 +/- 0.2 and 1.8 +/- 0.1, respectively, and the ratios between central and peripheral 99mTc radioactivity counts were 2.4 +/- 0.1 and 2.3 +/- 0.2, respectively. No significant difference was observed in bronchial clearance values between patients with heart/lung and double-lung transplants (26.4 +/- 3.0 percent/h vs 35.9 +/- 3.5 percent/h). Conversely, bronchial clearance was significantly lower in transplant recipients (30.0 +/- 2.5 percent/h) than in normal controls (58.7 +/- 6.2 percent/h; p < 0.001). This decreased bronchial clearance can be expected to increase the risk of lung infection in long-term survivors of heart/lung and double-lung transplantation.
本研究的目的是调查心肺联合移植和双肺移植后的支气管黏液纤毛清除功能。采用无创放射性气溶胶技术测量支气管黏液纤毛清除功能：使用旋转顶部发生器将99mTc标记的白蛋白雾化（质量中位空气动力学直径为7.5μm；几何标准差为1.5μm）。用γ相机在60分钟内采集放射性计数。在由133Xe肺通气图像勾勒出的右肺上绘制感兴趣区域。支气管黏液纤毛清除功能通过单指数模型拟合的时间-活性曲线计算每小时放射性减少的百分比来评估。为排除急性肺排斥、机会性肺部感染和闭塞性细支气管炎患者，所有移植患者在清除功能测量前均接受了肺功能测试和支气管镜检查。对8例心肺联合移植和5例双肺移植的非吸烟患者进行了研究，这些患者术后19.3±4.0个月，肺组织学正常，并与9例正常非吸烟者进行了比较。移植患者和气溶胶在正常受试者中的近端沉积相似；气溶胶放射性计数分布直方图的偏斜值分别为2.1±0.2和1.8±0.1，中央与外周99mTc放射性计数之比分别为2.4±0.1和2.3±0.2。心肺联合移植和双肺移植患者的支气管清除值之间未观察到显著差异（分别为每小时26.4±3.0%和35.9±3.5%）。相反，移植受者的支气管清除率（每小时30.0±2.5%）显著低于正常对照组（每小时58.7±6.2%；p<0.001）。预计这种支气管清除功能的降低会增加心肺联合移植和双肺移植长期存活者肺部感染的风险。
