Ikonen T, Kivisaari L, Harjula A L, Lehtola A, Heikkilä L, Kinnula V L, Kyösola K, Savola J, Sipponen J, Verkkala K, Mattila S P
Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
J Heart Lung Transplant. 1996 Jun;15(6):587-95.
Chronic rejection is a major long-term complication after lung transplantation. The purpose of our study was to evaluate the role of repeated high-resolution computed tomographic examinations in monitoring the development of bronchiolitis obliterans syndrome after lung transplantation.
A total of 126 high-resolution computed tomographic examination in 13 lung transplant recipients was analyzed. During a mean follow-up period of 23 months, bronchiolitis obliterans syndrome developed in eight of the patients. A scoring system from 0 to 10 based on the number of chronic changes on high-resolution computed tomography was developed, and the score of each patient was compared with decline in the forced expiratory volume in 1 second and maximal forced expiratory flow rate of 50% of the forced vital capacity.
The score of chronic changes, measured at 1 year after transplantation, correlated inversely with the values of forced expiratory volume in 1 second and maximal forced expiratory flow rate at 50% of the forced vital capacity (p < 0.05). Stage I bronchiolitis obliterans syndrome was associated with scores of 4 to 6 (mean 5.0), stage 2 with scores of 6 to 9 (mean 7.0), and stage 3 with scores of 6 to 9 (mean 7.7). The sensitivity of high-resolution computed tomography was 93% and its specificity was 92% when five chronic changes were used as a cutoff level.
The progress of chronic changes on high-resolution computed tomography occurs concurrently with the development of bronchiolitis obliterans syndrome. High-resolution computed tomography may provide additional morphologic information for noninvasive evaluation of chronic lung rejection.
慢性排斥反应是肺移植术后主要的长期并发症。本研究的目的是评估重复高分辨率计算机断层扫描检查在监测肺移植术后闭塞性细支气管炎综合征发展中的作用。
分析了13例肺移植受者的126次高分辨率计算机断层扫描检查。在平均23个月的随访期内，8例患者发生了闭塞性细支气管炎综合征。基于高分辨率计算机断层扫描上慢性改变的数量建立了一个从0到10的评分系统，并将每位患者的评分与一秒用力呼气量和用力肺活量50%时的最大用力呼气流量的下降情况进行比较。
移植后1年测得的慢性改变评分与一秒用力呼气量以及用力肺活量50%时的最大用力呼气流量值呈负相关（p<0.05）。I期闭塞性细支气管炎综合征的评分为4至6分（平均5.0分），II期为6至9分（平均7.0分），III期为6至9分（平均7.7分）。当以五个慢性改变作为临界值时，高分辨率计算机断层扫描的敏感性为93%，特异性为92%。
高分辨率计算机断层扫描上慢性改变的进展与闭塞性细支气管炎综合征的发展同时发生。高分辨率计算机断层扫描可为慢性肺排斥反应的无创评估提供额外的形态学信息。
