肺移植术治疗特发性肺间质纤维化患者近期预后及影响因素分析

Short-term prognosis of lung transplantation for patients with idiopathic pulmonary fibrosis and its influencing factors

目的探讨肺移植治疗特发性肺间质纤维化（IPF）的近期预后及其影响因素。方法分析2014年1月至2017年6月行肺移植术的89例IPF患者相关资料,统计其近期预后（90 d内存活率）,并据此分为存活组与死亡组,分析影响患者早期预后的危险因素。结果术后90 d内存活率84.27%,死亡率15.73%;存活组术前合并肺动脉高压、术后感染率、急性排斥反应（AR）发生率、重症监护病房（ICU）入住时间、均低于死亡组（P〈0.05）。单肺移植患者年龄大于双肺移植者,平均肺动脉收缩压小于双肺移植者（P〈0.05）。Logistic多因素回归分析显示IPF患者肺移植术后早期死亡的独立危险因素包括术前合并肺动脉高压、术后感染、ICU入住时间长。结论肺移植治疗IPF有效,单肺、双肺移植早期预后相当,对年轻、肺动脉压力较高者首选双肺移植;术前合并肺动脉高压、术后感染、ICU入住时间长是影响IPF患者术后早期预后的危险因素。

Objective To investigate the short-term prognosis of lung transplantation for idiopathic pulmonary fibrosis（ IPF）and its influencing factors.Methods The related data of 89 patients with IPF who underwent lung transplantation during the period from January 2014 to June 2017 were analyzed retrospectively.The short-term prognosis（ survival rate within 90 days） was statistically analyzed,and patients were divided into the survival group and death group according to the analyzed results. Risk factors affecting the early prognosis of patients were analyzed.Results The survival rate and mortality rate within 90 days after operation were 84. 27% and 15. 73%,respectively.The rate of combined pulmonary hypertension before operation,postoperative infection rate,incidence of acute rejection（ AR） and length of stay in intensive care unit（ ICU） in the survival group were lower than those in the death group（ P 0. 05）.Patients undergoing single lung transplantation were significantly older than that undergoing double lung transplantation,and the mean pulmonary artery systolic pressure was significantly lower than that of patients undergoing double lung transplantation（ P 0. 05）.Logistic multivariate regression analysis showed that independent risk factors for early death of patients with IPF undergoing double transplantation included preoperative pulmonary hypertension,postoperative infection and long stay in ICU. Conclusion Lung transplantation is effective in the treatment of IPF.The early prognosis of single lung and double lung transplantation is similar.For young patients and patients with relatively higher pulmonary artery pressure,double lung transplantation is preferred.Complicated with pulmonary hypertension before operation,postoperative infection and long stay in ICU are risk factors for early prognosis of these patients.