缺血再灌注肺损伤对肺移植临床效果的影响

Impact of ischemia-reperfusion injury on outcome following lung transplantation

目的分析肺移植受者缺血再灌注肺损伤的发生情况及其对肺移植临床效果的影响。方法2005年8月至2010年12月单中心实施肺移植共28例，符合入选标准者24例。人选者按72h内是否发生缺血再灌注肺损伤分为原发性肺移植功能障碍（PGD）组和非PGD组。统计受者PGD的发生率，按照国际心肺移植协会（ISHLT）的分级标准对PGD进行分级。比较术后不同时间受者PGD分级的差异，分析PGD对术后机械通气时间、重症监护病房住院时间、总住院时间的影响，比较两组受者术后30d、3个月的存活率及术后1年的肺功能改善程度。结果24例受者PGD的发生率为66．7％（16／24），其中重度（3级）PGD发生率为46．43％（13／28）。肺再灌注0～24h、24-48h和48-72h，受者PGD分级的差异有统计学意义（P〈0．01），重度PGD多发生在肺移植后48h内。肺移植后30d内，PGD组重度PGD病死率为6．2％（1／16），非PGD组为0；肺移植后3个月内，PGD组病死率为25．0％（4／16），非PGD组为0；但两个时间点两组病死率的差异均无统计学意义（P〉0．05）。PGD组机械通气时间中位数为91．1h，长于非PGD组的19．2h，差异有统计学意义（P〈0．05）。两组肺移植后1年内肺功能改善值、6min步行试验行走距离的差异均无统计学意义（P〉0．05）。结论PGD是肺移植患者早期的主要并发症，其会造成移植患者的机械通气时间延长，有可能影响肺移植的早期和远期效果。

Objective Primary graft dysfunction （PGD） is a severe form of ischemia-reperfusion injury （IRI） developing in the early days of post-lung transplantation （LT）. We aimed to investigate the incidence and severity grading of PGD, and analyze the impact of PGD on early morbidity and mortality after LT as well as on long-term function and survival. Method Twenty-eight consecutive recipients undergoing LT were collected at Beijing Chao-Yang Hospital between Aug. 2005 and Dec. 2010, and 24 LT recipients were enrolled in this study. The incidence of PGD was calculated and the recipients were classified by standardized consensus criteria reported by the International Society for Heart and Lung Transplantation （ISHLT） Working Group on PGD. The difference was compared among T0-24, T24-48 and T48-72. The incidence of PGD, PGD grading and impact of PGD on early morbidity and mortality after LT as well as on long-term function and survival were analyzed. Result The incidence of PGD after LT was 66. 7% （16/24）. The incidence of severe PGD （grading 3） was 54. 2% （13/24）. There was significant difference among T0-24, T24-48 and T48-72 in the severity grading of POD （P〈0. 01 ）. At 30th day and 3rd month post-LT, one and 4 died, respectively, among LT recipients with PGD. There was no death in LT recipients without PGD. The all-cause mortality rate had no statistically significant difference between the two groups （P〉 0. 05）. The median duration of mechanical ventilation in LT recipients with or without PGD was 91.1 h and 19. 2 h respectively （P〈0. 05）. The improvements of pulmonary function and 6 Minute Walk Test （6MWT） within one year after LT showed no statistically significant difference between LT recipients with PGD and those without PGD （P 〉 0.05 ）. Conclusion MBL gene single nucleotide polymorphisms may influence CMV infection after HSCT.