终末期肺病患者等待肺移植期间的临床分析

Outcome of patients with end-stage pulmonary disease awaiting lung transplantation

目的总结单中心终末期肺病患者等待肺移植期间的临床结局及其影响因素，探讨等待期患者排序的参考因素。方法回顾性分析自2003年1月至2013年1月83例等待肺移植的终末期肺病患者的临床资料。结果22例（26．5％）患者死于等待期，41例（49．4％）接受同种异体肺移植，20例（24．1％）仍在等待供肺。相对于慢性阻塞性肺疾病（COPD）患者，特发性肺纤维化（IPF）患者等待期间死亡率较高，死亡率分别为39．1％和15．6％（P=0．09）。存活患者的等待期存活时间为（377．5±527．6）d，死亡患者的等待期存活时间为（181．7±196．9）d（P=0．016）。存活的患者的平均肺动脉压力为（38．8±14．1）mmHg（1mmHg=0．133kPa），死亡患者的平均肺动脉压力为（54．3±25．9）mmHg（P=0．08）。死亡病例中，IPF患者的存活时间为（137．8±199．6）d，其他疾病患者为（212．1±196．9）d（P=0．397）。等待期需要常规氧疗和无创正压通气的患者的死亡率为23．9%，接受机械通气患者的死亡率为41．7％（P=0．287）。结论原发疾病的类型、肺动脉高压和机械通气可能是影响终末期肺病患者等待期预后的主要因素，拟定肺移植等待排序时应综合考虑上述因素。

Objective To characterize the outcome of patients referral for lung transplantation at a single center, and to identify the prognosis factors for death while they are on the waiting list. Methods From January 2003 to January 2013, the clinical data of 83 patients with end-stage lung disease referral for lung transplantations consecutively in our center were analyzed retrospectively. Results Twenty-two patients （26. 5%） died while waiting. Forty-one patients （49. 4%） underwent lung transplantation, and 20 patients （24. 1%） were still on the wait list. Compared to idiopathic pulmonary fibrosis （IPF） patients, the candidates with chronic obstructive pulmonary disease （COPD） had the higher chance of a transplantation （57. 8% vs. 43.5%）. However, patients with IPF had the higher probability of dying while waiting （39. 1% vs. 15.6%, P = 0. 09）. The mean waiting time was shorter （377.5 vs. 181.7 days, P = 0. 016）, and the mean pulmonary arterial pressure was lower （38. 8 mmHg vs. 54. 3 mmHg, P = 0. 08） in the survival group than in the expired group. In the expired group, compared to other candidates, the mean survival time was shorter in patients with IPF than in other candidates （137. 8 days vs. 212. 1 days, P = 0. 397）. Those patients requiring the mechanical ventilation had the higher probability of dying while waiting （41.7% vs. 23.9%, P = 0. 287） than other patients. Conclusion The type of end-stage lung disease, pulmonary hypertension and mechanical ventilation may be distinctive prognosis factors for death on the lung transplantation wait list. When determining the lung allocation schemes, the type of disease and the medical urgency of transplantation should be taken into account together.