肺移植受者闭塞性细支气管炎综合征的季节性发作

Seasonal onset of bronchiolitis obliterans syndrome in lung transplant recipients.

作者信息

Hohlfeld J, Niedermeyer J, Hamm H, Schäfers H J, Wagner T O, Fabel H

机构信息

Hannover Medical School, Department of Respiratory Medicine, Germany.

出版信息

J Heart Lung Transplant. 1996 Sep;15(9):888-94.

PMID:8889984

Abstract

BACKGROUND

Bronchiolitis obliterans syndrome is the major complication in long-term survival of patients with lung transplants. Bronchiolitis obliterans syndrome is thought to represent a form of chronic allograft rejection and is associated with obstructive airways disease. Viral infections or other exogenous factors may trigger this condition.

METHODS

Because respiratory viral infections show seasonal clustering we studied seasonal onset of bronchiolitis obliterans syndrome in 157 lung and heart-lung transplant recipients. Individual baseline values of forced expiratory volume in 1 second were evaluated according to the International Society for Heart and Lung Transplantation criteria. For bronchiolitis obliterans syndrome classification, values of forced expiratory volume in 1 second were determined by the average of two measurements made at least 1 month apart. Onset of bronchiolitis obliterans syndrome was defined as the date of the initial pulmonary function test showing a persistent decline of forced expiratory volume in 1 second. Other factors causing obstructive airways disease were excluded.

RESULTS

Forty-nine patients (31%) showed development of bronchiolitis obliterans syndrome (n = 10 stage I, n = 13 stage II, n = 26 stage III) with onset of bronchiolitis obliterans syndrome 507 +/- 372 days (mean +/- standard deviation) after transplantation. Baseline value of forced expiratory volume in 1 second was reached at 270 +/- 231 days. Between January and March of each year onset of bronchiolitis obliterans syndrome developed in 23 patients (47%). In the second (April to June) and third (July to September) quarters a persistent decline of pulmonary function test results developed in 13 (27%) and 12 (24%) patients, respectively, whereas only 1 patient (2%) showed deterioration between October and December (p < 0.001).

CONCLUSIONS

Seasonal clustering of onset of bronchiolitis obliterans syndrome might thus indicate underlying unknown infectious triggers.

摘要

背景

闭塞性细支气管炎综合征是肺移植患者长期存活的主要并发症。闭塞性细支气管炎综合征被认为是慢性移植物排斥反应的一种形式，与阻塞性气道疾病相关。病毒感染或其他外部因素可能引发这种情况。

方法

由于呼吸道病毒感染呈现季节性聚集，我们研究了157例肺移植和心肺联合移植受者中闭塞性细支气管炎综合征的季节性发病情况。根据国际心肺移植学会标准评估一秒用力呼气量的个体基线值。对于闭塞性细支气管炎综合征的分类，一秒用力呼气量的值由至少相隔1个月进行的两次测量的平均值确定。闭塞性细支气管炎综合征的发病定义为首次肺功能测试显示一秒用力呼气量持续下降的日期。排除其他导致阻塞性气道疾病的因素。

结果

49例患者（31%）出现闭塞性细支气管炎综合征（I期10例，II期13例，III期26例），闭塞性细支气管炎综合征发病于移植后507±372天（平均值±标准差）。一秒用力呼气量的基线值在270±231天达到。每年1月至3月有23例患者（47%）发生闭塞性细支气管炎综合征。在第二季度（4月至6月）和第三季度（7月至9月），分别有13例（27%）和12例（24%）患者的肺功能测试结果持续下降，而10月至12月仅有1例患者（2%）出现恶化（p<0.001）。