Clinical impact of community-acquired respiratory viruses on bronchiolitis obliterans after lung transplant
Clinical impact of community-acquired respiratory viruses on bronchiolitis obliterans after lung transplant
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DOI：
10.1111/j.1600-6143.2005.00971.x
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发表时间：
2005-08-01
影响因子：
8.8
通讯作者：
Humar, A
中科院分区：
文献类型：
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作者：
Kumar, D;Erdman, D;Humar, A
肺移植受者的社区获得性病毒呼吸道感染(RTI)可能有很高的肺炎进展速度，并可能触发免疫介导的对肺功能的不利影响。2001年至2003年共登记了100名患者，其中50名患者被临床诊断为病毒性RTI，50名患者无症状。所有患者均取鼻咽和咽拭子进行呼吸道病毒抗原检测、培养和RT-PCR。所有患者均定期进行肺功能检查，持续12个月。在3个月的主要终点比较排斥反应、用力呼气量下降(L)1例S(FEV-1)以及细菌和真菌重叠感染的发生率。在50例RTI患者中，33例(66%)被确定为微生物病原体，包括鼻病毒(9例)、冠状病毒(8例)、呼吸道合胞病毒(6例)、甲型流感(5例)、副流感(4例)和人类偏肺病毒(1例)。在3个月的主要终点期间，50例RTI患者中有8例(16%)发生了急性排斥反应，而50例非RTI患者中0例发生了急性排斥反应(p=0.006)。FEV-1在3个月内下降20%或以上的患者数量为9/50(18%)，而50例非RTI患者中为0(0%)(p=0.003)。在这9名患者中，有6名患者的FEV-1下降持续了1年，与闭塞性毛细支气管炎综合征(BOS)一致。社区获得性呼吸道病毒可能与急性排斥反应和BOS的发生有关。
Community-acquired viral respiratory tract infections (RTI) in lung transplant recipients may have a high rate of progression to pneumonia and can be a trigger for immunologically mediated detrimental effects on lung function. A cohort of 100 patients was enrolled from 2001 to 2003 in which 50 patients had clinically diagnosed viral RTI and 50 were asymptomatic. All patients had nasopharyngeal and throat swabs taken for respiratory virus antigen detection, culture and RT-PCR. All patients had pulmonary function tests at regular intervals for 12 months. Rates of rejection, decline in forced expiratory volume (L) in 1 s (FEV-1) and bacterial and fungal superinfection were compared at the 3-month primary endpoint. In the 50 patients with RTI, a microbial etiology was identified in 33 of 50 (66%) and included rhinovirus (9), coronavirus (8), RSV (6), influenza A (5), parainfluenza (4) and human metapneumovirus (1). During the 3-month primary endpoint, 8 of 50 (16%) RTI patients had acute rejection versus 0 of 50 non-RTI patients (p = 0.006). The number of patients experiencing a 20% or more decline in FEV-1 by 3 months was 9 of 50 (18%) RTI versus 0 of 50 non-RTI (0%) (p = 0.003). In six of these nine patients, the decline in FEV-1 was sustained over a 1-year period consistent with bronchiolitis obliterans syndrome (BOS). Community-acquired respiratory viruses may be associated with the development of acute rejection and BOS.