消化管静止是慢性肺异位移植功能障碍和肺移植接受者的异位移植失败的危险因素
Rayoun Ramendra1, Juan C Fernández-Castillo1,2, Ella Huszti3
1Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada.
ERJ open research
|October 11, 2023
概括
肺移植受体患有食管胃节外流阻塞或主要食管运动障碍的人面临更高的慢性肺异位功能障碍和异位移植失败的风险. 早期识别有助于针对志向事件的个性化预防策略.
科学领域:
- 胃肠病学 胃肠病学
- 肺部病理学 肺部病理学
- 移植手术 移植手术
背景情况:
- 经常与食道和胃部疾病相关的反复吸收事件,有助于肺移植接受者的发病率和死亡率.
- 此前关于食道功能和慢性肺异位移植功能障碍 (CLAD) 的研究已经产生了相互矛盾的结果.
- 这项研究研究了食道运动障碍与长期结果之间的关联,在一大群肺移植患者中.
研究的目的:
- 检查食道运动障碍与肺移植接受者的长期结果之间的关系.
- 评估特定食道疾病对CLAD和全移植失败的发展的影响.
- 在这个患者群体中,为预防志愿症提供风险分层和个性化治疗信息.
主要方法:
- 来自多伦多肺移植计划 (2012-2018) 的487名肺移植接受者的回顾性分析.
- 纳入标准包括食管测量测试在移植后7个月内.
- 患者使用"芝加哥食道疾病分类" (v3.0) 进行分类,并评估了与CLAD和全移植失败的关联.
主要成果:
- 在12%的患者中发现了食管胃节外流阻塞 (OGJOO),并与CLAD和全移植失败的风险增加有关 (HR分别为1.71和1.69).
- 在10%的患者中发现了周平静的主要障碍,并显著增加了CLAD和全移植失败的风险 (HR分别为1.55和3.33).
- 周围静脉的轻微障碍与不良结果没有显著的关联.
结论:
- 用OGJOO或主要围静性疾病表示的食道静止与肺移植受体的长期结果较差有关.
- 这些发现支持使用食道测量仪进行风险分层.
- 基于已识别的食道运动障碍,可以制定个性化的吸血预防策略.
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