Bjørtuft O, Geiran O R, Fjeld J, Skovlund E, Johansen B, Boe J
Department of Thoracic Medicine, Rikshospitalet, University Hospital, Oslo, Norway.
Respir Med. 1996 Oct;90(9):553-9. doi: 10.1016/s0954-6111(96)90148-1.
Chronic obstructive pulmonary disease (COPD) is now the most common indication for single lung transplantation. In long-term follow-up, obliterative bronchiolitis is a major problem. The aim of the present study was to perform a long-term follow-up of the pulmonary function and to examine the effect of development of bronchiolitis obliterans syndrome (BOS). Nineteen patients with end-stage COPD underwent single lung transplantation and were followed regularly with pulmonary function tests, and ventilation and perfusion scintigraphy (mean observation time 29 months). They were divided into two categories, with and without BOS, using the definition recommended by the International Society for Heart and Lung Transplantation working group. A mixed model analysis of variance with BOS as co-variate was used to evaluate its effect on pulmonary function. Spirometry, lung transfer factor for carbon monoxide (TLCO), arterial blood gases and 6-min walk test improved significantly (P < 0.001) from before transplantation to 3 months after transplantation. Nine patients developed BOS. Implied by the definition of the syndrome, forced expiratory volume in 1 s (FEV1) was significantly (P < 0.001) lower for patients with BOS while there was no significant effect of BOS category on TLCO corrected for alveolar volume (VA) or perfusion to transplant. Patients without BOS maintained their pulmonary function, and ventilation and perfusion to transplant for more than 3 yr after transplantation. The present results suggest that decreasing FEV1 accompanied by an unchanged TLCO/VA and pulmonary perfusion support the diagnosis of BOS after single lung transplantation for COPD.
慢性阻塞性肺疾病（COPD）目前是单肺移植最常见的适应证。在长期随访中，闭塞性细支气管炎是一个主要问题。本研究的目的是对肺功能进行长期随访，并研究闭塞性细支气管炎综合征（BOS）发展的影响。19例终末期COPD患者接受了单肺移植，并定期进行肺功能测试、通气和灌注闪烁扫描（平均观察时间29个月）。根据国际心肺移植协会工作组推荐的定义，将他们分为有BOS和无BOS两类。以BOS作为协变量的方差混合模型分析用于评估其对肺功能的影响。从移植前到移植后3个月，肺活量测定、一氧化碳肺转移因子（TLCO）、动脉血气和6分钟步行试验均有显著改善（P < 0.001）。9例患者发生了BOS。根据该综合征的定义，有BOS的患者1秒用力呼气量（FEV1）显著降低（P < 0.001），而BOS类别对校正肺泡容积（VA）后的TLCO或移植灌注无显著影响。无BOS的患者在移植后3年多保持了肺功能、通气和移植灌注。目前的结果表明，单肺移植治疗COPD后，FEV1降低而TLCO/VA和肺灌注不变支持BOS的诊断。
