Are symptom reports useful for differentiating between acute rejection and pulmonary infection after lung transplantation?
Are symptom reports useful for differentiating between acute rejection and pulmonary infection after lung transplantation?
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DOI：
10.1016/j.hrtlng.2004.05.001
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发表时间：
2004-11-01
期刊：
影响因子：
2.8
通讯作者：
Dauber, JH
中科院分区：
文献类型：
--
作者：
Dabbs, AD;Hoffman, LA;Dauber, JH
背景：及时治疗急性排斥反应和肺部感染可降低肺移植受者的发病率和死亡率。使用症状、肺活量测定和支气管镜检查来检测这些并发症。其中，症状报告是侵入性最小的，但很少受到严格的检查。目的：探讨使用咳嗽和呼吸短促等症状报告来识别肺移植术后临床显著的急性排斥反应和肺部感染的可能性。方法：在常规随访期间，比较有临床显著急性排斥反应（大于或等于A2级）和无临床显著急性排斥反应（A0或A1级）的肺移植受者（LTR）以及有排斥反应（大于或等于A2级）和肺部感染的肺移植受者（LTR）的症状。结果：LTR伴排斥反应（大于或等于A2级）报告的症状多于无排斥反应（A0级、A1级）的患者（P < 0.01）；然而，差异的幅度是最小的。LTR伴临床显著急性排斥反应（等级大于或等于A2）报告的症状率与肺部感染患者相当。结论：尽管症状可以提醒LTR注意病情的变化，但没有症状（呼吸、全身或日常生活活动[ADL]）可以区分排斥反应或肺部感染的等级。
BACKGROUND: Prompt treatment of acute rejection and pulmonary infection reduces morbidity and mortality in lung transplant recipients. Symptoms, spirometry, and bronchoscopy are used to detect these complications. Of these, symptom reporting is the least invasive, yet has received little critical examination.OBJECTIVE: To examine the potential for using reports of symptoms, such as cough and shortness of breath, to recognize clinically significant acute rejection and pulmonary infection after lung transplantation.METHODS: Symptoms reported during routine follow-up visits were compared between lung transplant recipients (LTR) with clinically significant acute rejection (grade greater than or equal to A2) and those without (grade A0 or A1) and between LTR with rejection (grade greater than or equal to A2) and those with pulmonary infection.RESULTS: LTR with rejection (grade greater than or equal to A2) reported more symptoms (P < .01) than did those without (grade A0, A1); however, the magnitude of difference was minimal. LTR with clinically significant acute rejection (grade greater than or equal to A2) reported symptoms at a rate comparable with those having pulmonary infection.CONCLUSIONS: Although symptoms may alert LTR to changes in their condition, no symptoms (respiratory, general, or activities of daily living [ADL]) differentiate between grades of rejection or pulmonary infection.