The Site and Nature of Airway Obstruction after Lung Transplantation
The Site and Nature of Airway Obstruction after Lung Transplantation
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DOI：
10.1164/rccm.201310-1894oc
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发表时间：
2014-02-01
影响因子：
24.7
通讯作者：
Vanaudenaerde, Bart M.
中科院分区：
文献类型：
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作者：
Verleden, Stijn E.;Vasilescu, Dragos M.;Vanaudenaerde, Bart M.
基本原理：肺移植慢性排斥反应可归因于进行性小气道阻塞。目的：准确确定这种类型的气道阻塞的部位和性质。方法：采用多层螺旋CT（MDCT）对接受第二次移植的排斥性肺移植患者（n = 7）的肺与未使用的供体（对照）肺（n = 7）进行比较。以确定在每个气道生成中可见的气道阻塞的百分比，微型计算机断层扫描（microCT）以使阻塞部位可视化，以及组织学以确定该阻塞的性质。测量和主要结果：在排异肺和对照肺之间，用MDCT可见的气道数目没有差异。然而，在排斥肺中，10 +/- 7%的观察到的直径大于2 mm的气道、50 +/- 22%的直径在1 mm和2 mm之间的气道和73 +/- 10%的直径小于1 mm的气道被阻塞。MicroCT证实阻塞气道的平均管腔直径为647 6 317 mm，但两组间终末细支气管总数、横截面积和肺泡直径（平均线性截距）均无差异（P > 0.05）。此外，microCT显示只有部分气道阻塞。组织学证实了毛细支气管炎的狭窄形式所造成的扩张的微血管丰富的肉芽组织在某些位置和胶原丰富的瘢痕组织在others.Conclusions：慢性肺移植排斥反应与进行性形式的缩窄性毛细支气管炎，目标进行气道，同时保留较大的气道，以及终端细支气管和肺泡表面。
Rationale: The chronic rejection of lung allografts is attributable to progressive small airway obstruction.Objectives: To determine precisely the site and nature of this type of airway obstruction.Methods: Lungs from patients with rejected lung allografts treated by a second transplant (n = 7) were compared with unused donor (control) lungs (n = 7) using multidetector computed tomography (MDCT) to determine the percentage of visible airways obstructed in each airway generation, micro-computed tomography (microCT) to visualize the site of obstruction, and histology to determine the nature of this obstruction.Measurements and Main Results: The number of airways visible with MDCT was not different between rejected and control lungs. However, 10 +/- 7% of observed airways greater than 2 mm in diameter, 50 +/- 22% of airways between 1 and 2 mm in diameter, and 73 +/- 10% of airways less than 1 mm in diameter were obstructed in the rejected lungs. MicroCT confirmed that the mean lumen diameter of obstructed airways was 647 6 317 mm but showed no difference in either total number and cross-sectional area of the terminal bronchioles or in alveolar dimensions (mean linear intercept) between groups (P > 0.05). In addition, microCT demonstrated that only segments of the airways are obstructed. Histology confirmed a constrictive form of bronchiolitis caused by expansion of microvascular-rich granulation tissue in some locations and collagen-rich scar tissue in others.Conclusions: Chronic lung allograft rejection is associated with a progressive form of constrictive bronchiolitis that targets conducting airways while sparing larger airways as well as terminal bronchioles and the alveolar surface.