Outcomes and safety of surgical lung biopsy for interstitial lung disease
Outcomes and safety of surgical lung biopsy for interstitial lung disease
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DOI：
10.1378/chest.127.5.1600
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发表时间：
2005-05-01
期刊：
影响因子：
9.6
通讯作者：
Shorr, AF
中科院分区：
文献类型：
--
作者：
Lettieri, CJ;Veerappan, GR;Shorr, AF
研究目的：确定间质性肺疾病（ILD）患者，特别是特发性肺纤维化（IPF）患者手术肺活检（SLB）的安全性。设计：回顾性队列。设置：三级护理大学附属军事医学中心。患者：因疑似ILD接受SLB的个体。测量和结果：我们检查了被指定接受SLB的临床诊断为ILD的受试者的结局。SLB后的死亡率（在30天和90天评估）是主要终点。SLB并发症导致的死亡率作为次要终点。该队列包括83例患者（平均[+/- SD]年龄，57.3 ± 14.2岁;男性，57.8%）。略多于一半的受试者最终诊断为IPF。总体而言，30天和90天死亡率较低（分别为4.8%和6.0%）。IPF受试者在SLB方面表现良好（30天死亡率，7.1%），并且相对于非IPF形式ILD受试者，其死亡或并发症风险不高。围手术期死亡率的唯一预测因素是在SLB时需要机械通气（MV）或在接受SLB前接受免疫抑制。排除符合任一标准的患者后，IPF患者的总体SLB后90天死亡率为1.5%。大约40%的IPF患者最终被诊断为最初被认为有另一种形式的ILD.Conclusions：IPF患者耐受SLB良好。需要MV或免疫抑制与SLB后死亡风险增加相关。安全性问题不应妨碍临床疑似IPF患者转诊接受SLB。
Study objectives: To determine the safety of surgical lung biopsy (SLB) in patients with interstitial lung disease (ILD), and specifically in those with idiopathic pulmonary fibrosis (IPF).Design: Retrospective cohort.Setting: Tertiary care university-affiliated military medical center.Patients: Individuals undergoing SLB for suspected ILD.Measurements and results: We examined outcomes for subjects with a clinical diagnosis of ILD who had been designated to undergo SLB. Mortality (assessed at 30 and 90 days) following SLB represented the primary end point. Morbidity resulting from complications from SLB served as a secondary end point. The cohort included 83 patients (mean [+/- SD] age, 57.3 +/- 14.2 years; men, 57.8%). IPF was eventually diagnosed in slightly more than half of the subjects. Overall, 30-day and 90-day mortality rates were low (4.8% and 6.0%, respectively). Subjects with IPF did well with SLB (30-day mortality rate, 7.1%) and did not face a higher risk of either death or complications relative to individuals with non-IPF forms of ILD. The only predictors of perioperative mortality were either the need for mechanical ventilation (MV) at the time of SLB or being immunosuppressed prior to undergoing SLB. Excluding persons who met either criterion yielded an overall 90-day post-SLB mortality rate of 1.5% in persons with IPF. Approximately 40% of patients in whom IPF was eventually diagnosed were initially thought to have another form of ILD.Conclusions: Persons with IPF tolerate SLB well. Requiring MV or being immunosuppressed is associated with an increased risk for death following SLB. Safety concerns should not preclude referral for SLB in patients who are clinically suspected of having IPF.