Atelectasis--an unusual and late complication of lung transplant.
Atelectasis--an unusual and late complication of lung transplant.
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肺不张——肺移植的一种罕见的晚期并发症。
DOI：
10.1034/j.1399-0012.2002.01121.x
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发表时间：
2002
影响因子：
2.1
通讯作者：
deMello,DE
中科院分区：
文献类型：
--
作者：
Zhao,Y;Al-Kaade,S;Keller,CA;deMello,DE
我们报告了一个以前未被认识到的同种异体肺移植的晚期并发症-移植肺的持续复发性肺不张。患者在右肺移植后约2年因移植肺急性肺不张发生突发性严重呼吸窘迫。 当时的多个经支气管活检显示炎症轻微，没有排斥反应的证据。她接受了表面活性剂替代治疗，在表面活性剂安装后，她的萎陷肺完全扩张。为了消除获得性表面活性物质脂质或蛋白质缺乏的可能性，在经支气管肺活检中进行了表面活性物质蛋白的超微结构检查和免疫染色。在肺活检的超微结构检查中，与年龄匹配的对照组相比，每个肺泡的II型细胞数量和每平方微米II型细胞横截面积的板层体数量增加。我们的结论是，表面活性剂的脂质和蛋白质的合成是不受损害的，因为病人的表面活性剂替代治疗的反应，板层体的数量增加，可以反映一个表面活性剂功能缺陷的补偿机制。病人后来发展成乳腺癌，她死于乳腺癌。我们提出了功能性表面活性物质缺陷是迄今未被认识到的恶性肿瘤非转移性表现的可能性。
We report a previously unrecognized late complication of allograft lung transplantation – persistent recurrent atelectasis of the transplanted lung. The patient developed sudden, severe respiratory distress about 2 yr after a right lung transplant, because of acute atelectasis of her transplanted lung. Multiple transbronchial biopsies at the time revealed minimal inflammation and no evidence of rejection. She was treated with surfactant replacement therapy, and her collapsed lung fully expanded following surfactant installation. To eliminate the possibility of acquired deficiency of surfactant lipids or proteins, ultrastructural examination and immunostains for surfactant proteins were performed in a transbronchial lung biopsy. No deficiency of surfactant lipids or proteins was found. On ultrastructural examination of the lung biopsy, the number of Type II cells per alveolus and the number of lamellar bodies per square micron of Type II cell cross‐sectional area was increased compared with an age‐matched control. We conclude that synthesis of surfactant lipids and proteins was unimpaired and because of the patient's response to surfactant replacement therapy, that the increase in number of lamellar bodies could reflect a compensatory mechanism for a surfactant functional defect. The patient later developed breast carcinoma to which she succumbed. We raise the possibility that the functional surfactant defect is a hitherto unrecognized non‐metastatic manifestation of malignancy.