纤维支气管镜肺活检在准确诊断肺移植术后急性排斥反应中的作用

目的 探讨肺移植术后纤维支气管镜肺活检(TBLB)对准确诊断急性排斥反应(AR)的作用.方法 分析肺移植术后有完整TBLB随访资料的50例受者AR的诊断情况.肺移植术后50例受者常规进行TBLB共145例次.根据术后早期TBLB的病理学诊断结果,将受者分为早期AR组和早期无AR组.分析术后早期TBLB诊断AR的阳性率,术后远期两组受者AR发生率和TBLB对诊断AR的准确率.结果 术后早期受者AR发生率为44%(22/50).早期AR组22例受者中,经TBLB诊断为AR的共有25例次;TBLB对肺移植术后早期AR的诊断准确率为100%.受者术后远期AR发生率为22%(11/50),其中早期AR组和早期无AR组分别有5例和6例受者发生AR.TBLB对术后远期AR的诊断准确率为100%.所有发生AR的受者中,有61.1%的受者无典型的AR临床表现.结论 肺移植术后急性排斥反应无典型的临床表现,容易误诊,TBLB对诊断肺移植术后急性排斥反应具有较高的准确率.

Transbronchial lung biopsy in diagnosis of acute rejection after the lung transplantation

Objective To estimate the transbronchial lung biopsies (TBLB) for acute rejection (AR) in lung transplant recipients. Methods A retrospective study on 50 patients who underwent transplantation between September 2002 and July 2007 was conducted, and 145 TBLB taken from these patients were reviewed. Pathologically, all patients were classified into the early AR group and early non-AR group. The positive rate of TBLB in the early diagnosis of AR after operation, the long-term incidence of AR in both groups, and the diagnostic accuracy of TBLB to AR were analyzed. Results The incidence of AR in early period was 44 % (22/50). The accuracy of the TBLB to AR was 100 %. 61.1 % of the patients with AR had no typical clinical features. Conclusions AR without typical clinical features after lung transplantation is easily misdiagnosed. TBLB has a higher accuracy in the diagnosis of AR following the lung transplantation.