肺臟移植的女性患者器官衰竭風險較高


  May 27, 2005 (聖地亞哥) - 在美國胸腔醫學會的2005年國際年會上,賓州大學的研究人員發表指出,接受肺臟移植手術的女性,移植器官衰竭的風險,較之男性為高。
  
  賓州大學醫學院的肺部、過敏及重症醫學副教授Jason Christie醫師表示,女性的肺臟移植者,嚴重移植體衰竭的風險較之男性受贈者高出60%;女性受贈者的嚴重移植體衰竭,引發的相對風險為1.6。
  
  加州大學聖地亞哥分校的預防醫學教授Andrew Ries醫師表示,這是一項很有趣的研究,移植器官衰竭是因為免疫系統將之認為是外來物質;有一項可能,那就是與懷孕有關係。
  
  Ries醫師指出,女性會有不同反應,是另一項研究的議題;這是一項觀察性的研究,使用來自一大型資料庫的數據;這是一種關連性的證明,但看起來像是真正的結果;或許,所有的疾病都會因性別不同而有異。
  
  Christie醫師表示,嚴重的移植體器官衰竭是一項急性的肺部傷害,肺臟移植後,10%到15%的患者會產生這種現象;若存活的患者肺部充水,或有創傷的現象時,有50%會死亡或嚴重受損。
  
  賓州的研究人員,起始時對250位接受過肺臟移植的患者作檢視,然後,將該研究擴展至7,482位患者,期間為1994年至2002年;這些患者的資訊皆統籌整理於心肺移植國際協會的登錄資料中;使用多變因邏輯回歸分析法,研究人員對女性捐贈者及受贈者的性別,針對嚴重臟器衰竭的引發風險,進行評估;另外,捐贈者及受贈者性別之間的關係也一併檢視。
  
  潛在的共同變因,含缺血時間、移植的年度、器官保存液、移植型態、捐贈者與受贈者的體型大小,手術前所使用的皮質類固醇、捐贈者年齡、性別、人種及死因等;受贈者的年齡、人種及移植診斷皆經檢視。
  
  ATS會議的記者會上,Christie醫師表示,相較於男性受贈者,女性的移植體衰竭風險為1.6倍。
  
  Christie表示,看來,捐贈者的性別並不會造成移植體的器官衰竭,這個風險主要是掌握在受贈者身上;目前,捐贈者或受贈者的性別皆未列入考慮,捐贈者可以為男性或女性,而受贈者為女性。
  
  Christie表示,在控制過共同變因後,發現女性的確有著較高的風險;看起來,如果你是女性,肺臟移植引發的風險是會比較高。
  
  Christie醫師指出,這些潛在的風險有著許多解釋的理論,但並非都具有科學根據;可能,女性的免疫系統會因受孕的次數而受影響。
  
  其他,可能荷爾蒙系統也會使得婦女們處於高風險;Christie認為,無論如何,在本研究裡,看不出年長的婦女有何不同。
  
  Christie醫師最後指出,本研究的結果尚且需要多臨床中心的研究始得證實,更進一步對這些潛在風險作檢視,並確認是否可以用醫療的方式將之降低。

Women Lung Transplant Patients

By
Medscape Medical News

Linda Little

May 27, 2005 (San Diego) — Women undergoing lung transplants have a higher risk for graft dysfunction than men, reported University of Pennsylvania researchers here at the 2005 American Thoracic Society International Conference.

Women undergoing lung transplants have a 60% increased risk of developing primary graft dysfunction than male lung transplant recipients, said Jason Christie, MD, assistant professor of pulmonary, allergy, and critical care medicine, University of Pennsylvania Medical School. "Women recipients have a 1.6 relative risk for development of primary graft dysfunction."

"This is an interesting study," said Andrew Ries, MD, professor of medicine, family and preventive medicine, University of California San Diego, who commented on the study. "The issue with graft dysfunction is that the immune system is recognizing a foreign substance. One of the possibilities is related to pregnancies."

This is yet another study that shows women react differently, Dr. Ries said. "This is an observational study using data from a large database. It is an association, but it looked like a real finding. There may be real sex differences in all diseases.

Primary graft dysfunction is an acute lung injury that occurs in about 10% to 15% of patients following lung transplant, Dr. Christie said. About 50% of patients die or are seriously impaired if they survive after the lungs fill with fluid and scarring occurs.

The Pennsylvania researchers initially looked at 250 patients who had undergone lung transplantation, but then expanded the study to include 7,482 patients who underwent lung transplant in the U.S. between 1994 and 2002. The patient information was gathered through a registry of the International Society for Heart and Lung Transplant. Using multivariate logistic regression methods, the researchers assessed the risk of female donor and recipient sex in the development of primary graft dysfunction. In addition, the interaction of donor and recipient sex was tested.

Potential confounders including ischemic time; calendar year of transplant; preservation fluid; transplant type; size of donor and recipient; presurgical corticosteroids; donor age, race, and cause of death; and recipient age, race, and transplant diagnosis were examined.

Compared with male recipients, females recipients had 1.6 times the risk of developing graft dysfunction, Dr. Christie said at a press conference at the ATS meeting.

"It did not appear that the donor sex had an affect on graft dysfunction," Dr. Christie said. "The majority of the risk tended to be in hands of the recipient."

Presently, there is no consideration given as to the sex of the donor or the recipient, Dr. Christie said. "The transplant can be from woman donor to woman recipient or from man donor to woman recipient."

After controlling for confounding conditions, the increased risk for women held true, Dr. Christie said. "It appears that you are more at risk if you are a woman undergoing lung transplantation."

There are a lot of theories of some of the potential reasons, but not a lot of science at this time, Dr. Christie said. "It may be that the immune system of women is affected by how many pregnancies they have had."

Other theories are that the hormonal system may be involved in placing women at higher risk, Dr. Christie said. However, in this study, there was no change in risk in older women.

Dr. Christie said further multicentered studies will be required to confirm the results and further look at the potential reasons for this increased risk "to see if treatment can reduce the risk."

2005 ATS International Conference: Poster 419. Presented May 24, 2005.

Reviewed by Gary D. Vogin, MD

Linda Little is a freelance writer for Medscape.

    
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