经支气管冷冻活检与经支气管镊活检在肺移植急性细胞排斥反应检测中的应用：一项 Meta 分析。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia Pub Date : 2024-11-01 DOI:10.1016/j.arbres.2024.06.006

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引用次数: 0

摘要

背景：经支气管低温生物切片检查（TBCB）可提供更大的组织样本并改善取样深度，但由于现有研究的局限性，其在诊断肺移植患者急性细胞排斥反应（ACR）中的作用尚不明确。针对这一问题，我们进行了一项系统回顾和荟萃分析，以评估 TBCB 的有效性和安全性：我们对肺移植术后监测中的 TBCB 进行了全面的文献综述，评估了研究质量，并进行了荟萃分析，比较了 TBCB 和经支气管镊活检（TBFB）的诊断率，并评估了手术并发症：我们的荟萃分析纳入了 11 项研究，共计 915 名患者，结果显示 TBCB 对肺移植后 ACR 的诊断率为 38.27%（225/588），明显高于 TBFB 的 35.65%（251/704）。计算得出的逆方差加权几率比为 2.32（95% 置信区间：1.24-4.32；P=0.008）。漏斗图分析表明无重大发表偏倚。对 6 项研究进行的荟萃分析表明，与 TBFB 相比，TBCB 能显著提高移植后慢性排斥反应的诊断率（25.00% vs 10.93%，p=0.005）。我们的荟萃分析比较了 TBCB 和 TBFB 在肺移植术后监测中的安全性，发现两者在中重度出血（5.99% vs 6.31%，P=0.98）或气胸发生率（3.90% vs 3.29%，P=0.75）方面无明显差异：我们的研究表明，TBCB 可增强肺移植术后急性和慢性排斥反应的诊断，其安全性与 TBFB 相当。为确保在更广泛的临床实践中安全有效地应用 TBCB，有必要开展进一步研究并制定标准化程序。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Transbronchial Cryobiopsy Versus Transbronchial Forceps Biopsy for Acute Cellular Rejection Detection in Lung Transplantation: A Meta-Analysis

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Transbronchial Cryobiopsy Versus Transbronchial Forceps Biopsy for Acute Cellular Rejection Detection in Lung Transplantation: A Meta-Analysis

Background

Transbronchial cryobiopsy (TBCB) provides larger tissue samples and improved sampling depth, but its role in diagnosing acute cellular rejection (ACR) in lung transplant patients is unclear due to limitations in existing studies. To address this, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of TBCB.

Methods

A thorough literature review was conducted to evaluate TBCB in post-lung transplant surveillance, assessing the quality of studies and conducting a meta-analysis comparing diagnostic yields of TBCB and transbronchial forceps biopsy (TBFB), as well as evaluating procedural complications.

Results

Our meta-analysis, incorporating 11 studies with a total of 915 patients, showed that TBCB had a diagnostic rate of 38.27% (225/588) for ACR post-lung transplantation, notably higher than the 35.65% (251/704) for TBFB. The inverse-variance weighted odds ratio was calculated at 2.32 (95% confidence interval: 1.24–4.32; p = 0.008). Funnel plot analysis indicated no major publication bias. Meta-analysis of 6 studies demonstrated that TBCB, compared to TBFB, significantly increased the diagnostic rate for chronic rejection post-transplantation (25.00% vs 10.93%, p = 0.005). Our meta-analysis comparing the safety of TBCB and TBFB in post-lung transplant surveillance found no significant differences in moderate to severe bleeding (5.99% vs 6.31%, p = 0.98), or pneumothorax incidence (3.90% vs 3.29%, p = 0.75).

Conclusions

Our study indicates that TBCB may enhance the diagnosis of acute and chronic rejection post-lung transplantation with a safety profile comparable to TBFB. Further research and the development of standardized procedures are warranted to ensure the safe and effective application of TBCB in broader clinical practice.

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来源期刊

Archivos De Bronconeumologia Medicine-Pulmonary and Respiratory Medicine

CiteScore

3.50

自引率

17.50%

发文量

330

审稿时长

14 days

期刊介绍： Archivos de Bronconeumologia is a scientific journal that specializes in publishing prospective original research articles focusing on various aspects of respiratory diseases, including epidemiology, pathophysiology, clinical practice, surgery, and basic investigation. Additionally, the journal features other types of articles such as reviews, editorials, special articles of interest to the society and editorial board, scientific letters, letters to the editor, and clinical images. Published monthly, the journal comprises 12 regular issues along with occasional supplements containing articles from different sections. All manuscripts submitted to the journal undergo rigorous evaluation by the editors and are subjected to expert peer review. The editorial team, led by the Editor and/or an Associate Editor, manages the peer-review process. Archivos de Bronconeumologia is published monthly in English, facilitating broad dissemination of the latest research findings in the field.