与慢性肺异位移植功能障碍相关的临床特征 多中心队列中的进展.
Jamie L Todd1,2, Megan L Neely2,3, Jesse Y Hsu4
1Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA.
慢性肺异位移植功能障碍 (CLAD) 诊断时的客观临床测量预测了肺移植接受者的移植损失. 更高的CLAD阶段,早期发病和FVC损失增加了移植损失的风险,有助于预后.
科学领域:
- 肺部医学 肺部医学
- 移植免疫学 移植免疫学
- 临床结果研究研究
背景情况:
- 慢性肺异位移植功能障碍 (CLAD) 是肺移植失败的主要原因之一.
- 目前对CLAD的表型化方法不一致,缺乏标准化.
- 预测CLAD肺移植接受者的结果需要客观措施.
研究的目的:
- 为了确定在CLAD诊断时的常规临床测量是否预测了移植损失.
- 分析CLAD阶段,时间和肺功能下降对移植结果的影响.
- 确定用于分层CLAD进展风险的客观标记.
主要方法:
- 对2386名成年肺移植接受者的未来多中心队列 (肺移植结果组) 的分析.
- 使用国际心脏和肺移植协会标准定义可能的CLAD.
- 考克斯模型根据共变量进行调整,以评估从CLAD发病到移植损失的时间,检查CLAD阶段,早期发病,FVC损失和FEV1/FVC比率.
主要成果:
- 可能的CLAD发生在59.4%的患者中;大多数患者呈现1期CLAD和早期发病.
- 较高的CLAD阶段 (≥2),早期发病的CLAD和FVC损失显着与移植损失的风险增加有关.
- 矛盾的是,降低FEV1/FVC比率 (<0.7) 与较低的移植损失风险相关.
结论:
- 在CLAD发病时的常规,客观的临床测量有效预测到移植损失的进展.
- 基于客观措施的CLAD分层对患者预后至关重要.
- 这些发现可以为CLAD干预措施的未来临床试验的设计提供信息.
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