背景：胃食管反流病与肺移植患者的移植物功能障碍相关。识别误吸患者在临床上很重要，因为它可以实施适当的干预措施，如抗反流治疗。油红O（ORO）染色并确定脂质负载的巨噬细胞指数（LLMI）已被提出作为检测抽吸的非侵入性替代标记。这项研究的目的是前瞻性评估ORO染色在评估误吸风险中的临床应用。
方法：从2020年8月至2021年11月接受常规监测的肺移植患者获得的所有经支气管手术病理活检均纳入本研究。临床小组成员前瞻性地确定了活检前后每位患者的误吸风险类别（ARC），并记录了ARC变化的原因。
结果：本研究共纳入132例经支气管活检并发LLMI。51例（38.6%）LLMI低，包括54例中的21例（38.9％），根据经支气管活检结果建议进行抽吸。总的来说,19例（14.4％）的ARC活检后发生了变化，其中10例升级，9例降级。经支气管活检结果被认为是大多数病例（15/19;79％）中ARC变化的原因；只有少数（2/19;10.5％）是由于LLMI。值得注意的是,16例（12.1%）具有低LLMI和高风险的活检后ARC，9例（6.8%）具有高LLMI和低风险的活检后ARC。
结论：本研究观察到抽吸的临床评估更依赖于经支气管活检的结果。尽管LLMI在某些情况下可能会保留临床实用性，重新评估ORO检测的临床价值是谨慎的.
Gastroesophageal reflux disease with microaspiration has been associated with graft dysfunction in lung transplant patients. Identifying patients with aspiration is clinically important because it enables implementation of appropriate interventions like antireflux therapy. Oil Red O (ORO) staining with determination of the lipid-laden macrophage index (LLMI) has been proposed as a noninvasive surrogate marker in the detection of aspiration. The aim of this
study was to prospectively evaluate clinical utilization of ORO staining in the assessment of aspiration risk.
All transbronchial surgical pathology biopsies obtained in lung transplant patients undergoing routine surveillance from August 2020 through November 2021 were included in this
study. Clinical team members prospectively ascertained the aspiration risk category (ARC) of each patient both before and after biopsy findings and recorded reasons for change in ARC.
A total of 132 transbronchial biopsies with concurrent LLMI were included in the
study. LLMI was low in 51 cases (38.6%), including 21 of the 54 cases (38.9%) where aspiration was suggested based on the transbronchial biopsy findings. In total, 19 cases (14.4%) underwent a change in ARC post-biopsy including 10 that were upgraded and nine cases that were downgraded. Transbronchial biopsy findings were noted as the reason for change in ARC in the majority (15/19; 79%) of cases; only a minority (2/19; 10.5%) were due to the LLMI. Notably, 16 cases (12.1%) had a low LLMI with high-risk post-biopsy ARC and nine cases (6.8%) had a high LLMI with low-risk post-biopsy ARC.
This
study observed that clinical evaluation for aspiration relied more heavily on transbronchial biopsy findings. Although LLMI may retain clinical utility in some scenarios, reevaluation of the clinical value of ORO testing would be prudent.
