细胞溶解疗法对闭塞性细支气管炎综合征的影响。

The impact of cytolytic therapy on bronchiolitis obliterans syndrome.

作者信息

Date H, Lynch J P, Sundaresan S, Patterson G A, Trulock E P

机构信息

Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110, USA.

出版信息

J Heart Lung Transplant. 1998 Sep;17(9):869-75.

PMID:9773858

Abstract

BACKGROUND

Bronchiolitis obliterans syndrome (BOS) is the major cause of morbidity and death after lung transplantation. Therapy has focused on augmented immunosuppression with a variety of agents. Although transient responses are often achieved, sustained remission has been unusual. The outcome of cytolytic therapy for BOS at our center has been analyzed and is reported.

METHODS

Between July 1988 and July 1994, 233 patients underwent lung transplantation at Barnes-Jewish Hospital. Among 207 recipients (88.8%) who survived more than 3 months, 81 recipients (39%) had development of BOS; 48 of these patients underwent 64 courses of treatment with a cytolytic agent (antilymphocyte globulin, antithymocyte globulin, or OKT3 monoclonal antibody). The cases of BOS were retrospectively analyzed to determine the impact of cytolytic therapy.

RESULTS

The 4-year survival rate was significantly greater in recipients without BOS than in those with BOS (82.8% vs 46.0%; p < .05). Various clinical factors, including diagnosis, forced expiratory volume in 1 second at onset of BOS, presence or absence of pathologically proven bronchiolitis obliterans, type of transplant operation, cytomegalovirus serologic status, and cytomegalovirus pneumonia, were examined, but no significant predictor of survival after the development of BOS was discerned. The mean decrement in forced expiratory volume in 1 second was significantly reduced by cytolytic therapy (-23.5% +/- 2.3% in the 3 months before therapy vs -9.9% +/- 3.5% in the 3 months after the therapy; p < .002). Nevertheless, the stage of BOS progressed over time in spite of therapy in most cases, and only 4 recipients (4.9%) with BOS remained in a lower BOS stage 2 years after treatment.

CONCLUSIONS

Recipients with BOS had a significantly lower survival rate than recipients without BOS. No predictor of survival after the onset of BOS was identified. Although cytolytic therapy decreased the rate of decline in pulmonary function in the 3 months after treatment, the stage of BOS ultimately progressed in most patients.

摘要

背景

闭塞性细支气管炎综合征（BOS）是肺移植后发病和死亡的主要原因。治疗主要集中于使用多种药物增强免疫抑制。尽管常常能取得短暂反应，但持续缓解并不常见。我们分析并报告了本中心针对BOS的细胞溶解疗法的结果。

方法

1988年7月至1994年7月期间，233例患者在巴恩斯犹太医院接受了肺移植。在存活超过3个月的207例受者（88.8%）中，81例受者（39%）发生了BOS；其中48例患者接受了64个疗程的细胞溶解剂（抗淋巴细胞球蛋白、抗胸腺细胞球蛋白或OKT3单克隆抗体）治疗。对BOS病例进行回顾性分析以确定细胞溶解疗法的影响。

结果

无BOS的受者4年生存率显著高于有BOS的受者（82.8%对46.0%；p <.05）。对各种临床因素进行了检查，包括诊断、BOS发病时的第1秒用力呼气量、是否有病理证实的闭塞性细支气管炎、移植手术类型、巨细胞病毒血清学状态以及巨细胞病毒肺炎，但未发现BOS发生后生存的显著预测因素。细胞溶解疗法使第1秒用力呼气量的平均下降幅度显著降低（治疗前3个月为-23.5%±2.3%，治疗后3个月为-9.9%±3.5%；p <.002）。然而，尽管进行了治疗，大多数病例中BOS的阶段仍随时间进展，治疗后2年只有4例（4.9%）BOS受者处于较低的BOS阶段。