肾移植前后肺通气、弥散功能及肺部影像学变化

Changes of lung ventilation function, diffusion function and pulmonary imaging in renal transplant recipients

背景:慢性肾功能衰竭患者由于内环境的紊乱及免疫功能的低下,易受体内外致病因素的影响而发生心、肺病变。肾移植后传统非特异性免疫抑制剂的联合应用,成为肺损伤发生的高危因素。目的:随访观察肾移植患者移植前后肺功能检测指标及肺部影像学的动态变化。设计、时间及地点:病例自身对照观察,于2003-02/2006-05在解放军北京空军总医院呼吸科及泌尿外科完成。对象:纳入52例终末期肾病患者,均在解放军北京空军总医院接受肾移植手术。方法:分别于肾移植前、移植后3,6,12个月随访观察52例患者的自身肺功能变化,同期观察其肺部影像学变化。主要观察指标:肾移植患者肾移植前后肺通气功能、弥散功能及肺部影像学变化。结果:①肾移植前,肺功能异常者占79%,其中多以阻塞性通气功能障碍和弥散功能下降为突出表现。②移植后3个月,患者的弥散功能和阻塞性通气功能障碍有部分好转,但肺限制性通气功能障碍比移植前突出。③移植后6,12个月,近一半的患者肺功能趋于稳定在正常范围之内。④移植前肺功能和弥散功能的损害较肺部影像学明显,前者发生率为79%,后者为54%。肾移植后,肺部影像学明显改善,且以肺部间质性改变为主要表现。结论:肾移植能显著改善终末期肾病患者的肺功能,尤其是小气道功能和弥散功能。肾移植前后肺部影像学的异常主要表现为程度不同的肺间质性改变。

BACKGROUND： Due to the disordered internal environment and low immunological function, patients with chronic renal function failure are prone to be affected by etiological factor in vitro and in vivo, thus occurring cardiac or pulmonary lesions. OBJECTIVE： To explore the pulmonary function status and pulmonary imaging outcome of renal transplant recipients. DESIGN, TIME AND SETTING： A self-control observation was performed in the Department of Respiratory Medicine and Department of Urinary Surgery, General Hospital of Chinese PLA Air Force, （Beijing, China） from February 2003 to May 2006. PARTICIPANTS： Fifty-two patients with end-stage renal disease underwent renal transplantation in the General Hospital of Chinese PLA Air Force were enrolled in this study. METHODS： Pulmonary functions and imaging result were assessed in 52 patients that performed renal transplantation prior to transplantation, 3 months, 6 months, and 12 months posttransplantation. MAIN OUTCOME MEASURES： The pulmonary ventilation function, diffusion function and imaging changes pretransplantation and posttransplantation in renal transplant recipients. RESULTS： Prior to transplantation, pulmonary dysfunction was observed in 79% of the patients, especially obstructive ventilation function and diffusion capacity Were found to be disturbed. At 3 months posttransplantation, the obstructive ventilation and diffusion functions were improved, but restrictive ventilation dysfunction was more evident. At 6 and 12 months posttransplantation, almost half transplant recipients had normal and stable pulmonary function. Before transplantation, pulmonary function impairments and diffuse abnormalities were more evident than the pulmonary imaging outcomes, accounting for 79% and 54%, respectively. After transplantation, substantial interstitial alterations were found in the imaging results. CONCLUSION： Renal transplantation can significantly improve the pulmonary functions of patients with end-stage renal disease, especial small-airway functions and diffusion capacities. After transplantation, imaging abnormalities incline to pulmonary interstitial tissue.