肺移植术后需要临床干预的气道狭窄患者生存结局的影响因素

Influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation

    摘要
  • 摘要:
      目的  分析肺移植术后需要临床干预的气道狭窄患者生存结局的影响因素。
      方法  回顾性分析肺移植术后需要临床干预的66例气道狭窄患者的临床资料。采用单因素和多因素Cox回归模型分析所有气道狭窄患者和早期气道狭窄患者生存结局的影响因素，采用Kaplan-Meier法计算总生存率并绘制生存曲线。
      结果  66例气道狭窄患者，中位无气道狭窄时间为72（52，102）d，27%（18/66）发生中心气道狭窄，73%（48/66）发生远端气道狭窄。术后机械通气时间风险比（HR）1.037，95%可信区间（CI）1.005~1.070，P=0.024和手术类型（HR 0.400，95% CI 0.177~0.903，P=0.027）均与肺移植术后气道狭窄患者的生存结局存在相关性，术后机械通气时间越长，受者死亡风险越高；接受双肺移植的气道狭窄患者的总生存率优于单肺移植。在亚组分析中，3级原发性移植物失功（PGD）（HR 4.577，95% CI 1.439~14.555，P=0.010）和免疫抑制药（HR 0.079，95% CI 0.022~0.287，P<0.001）与肺移植术后早期气道狭窄患者生存结局均存在相关性；无3级PGD的肺移植术后早期气道狭窄患者的总生存率优于有3级PGD的患者，使用他克莫司的肺移植术后早期气道狭窄患者的总生存率优于使用环孢素的患者。
      结论  术后机械通气时间长、单肺移植手术方式、3级PGD和使用环孢素可能影响肺移植术后气道狭窄患者的生存。

     

    Abstract:
      Objective  To analyze the influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation.
      Methods  Clinical data of 66 patients with airway stenosis requiring clinical interventions after lung transplantation were retrospectively analyzed. Univariate and multivariate Cox’s regression models were adopted to analyze the influencing factors of survival of all patients with airway stenosis and those with early airway stenosis. Kaplan-Meier method was used to calculate the overall survival and delineate the survival curve.
      Results  For 66 patients with airway stenosis, the median airway stenosis-free time was 72 (52,102) d, 27% (18/66) for central airway stenosis and 73% (48/66) for distal airway stenosis. Postoperative mechanical ventilation time hazard ratio (HR) 1.037, 95% confidence interval (CI) 1.005-1.070, P=0.024 and type of surgery (HR 0.400, 95%CI 0.177-0.903, P=0.027) were correlated with the survival of patients with airway stenosis after lung transplantation. The longer the postoperative mechanical ventilation time, the higher the risk of mortality of the recipients. The overall survival of airway stenosis recipients undergoing bilateral lung transplantation was better than that of their counterparts after single lung transplantation. Subgroup analysis showed that grade 3 primary graft dysfunction (PGD) (HR 4.577, 95%CI 1.439-14.555, P=0.010) and immunosuppressive drugs (HR 0.079, 95%CI 0.022-0.287, P<0.001) were associated with the survival of patients with early airway stenosis after lung transplantation. The overall survival of patients with early airway stenosis after lung transplantation without grade 3 PGD was better compared with that of those with grade 3 PGD. The overall survival of patients with early airway stenosis after lung transplantation treated with tacrolimus was superior to that of their counterparts treated with cyclosporine.
      Conclusions  Long postoperative mechanical ventilation time, single lung transplantation, grade 3 PGD and use of cyclosporine may affect the survival of patients with airway stenosis after lung transplantation.

     

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