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中华移植杂志(电子版)

中华移植杂志(电子版) ›› 2025, Vol. 19 ›› Issue (06) : 414 -420. doi: 10.3877/cma.j.issn.1674-3903.2025.06.005

论著

纤支镜操作频率与脑死亡潜在供者肺脏成功获取的关联分析：基于倾向性评分的回顾性队列研究
郝鹏, 李珏菁, 宁寰坤, 丘小红†()   
  1. 510120　广州，中山大学孙逸仙纪念医院器官捐献与移植管理中心办公室
  • 收稿日期:2025-02-26 出版日期:2025-12-25
  • 通信作者: 丘小红

Association between bronchoscopy frequency and successful lung procurement in potential brain-dead donors: a propensity score matching retrospective cohort study

Peng Hao, Juejing Li, Huankun Ning, Xiaohong Qiu†()   

  1. Office of Organ Donation and Transplantation Management Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
  • Received:2025-02-26 Published:2025-12-25
  • Corresponding author: Xiaohong Qiu
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引用本文：

郝鹏, 李珏菁, 宁寰坤, 丘小红. 纤支镜操作频率与脑死亡潜在供者肺脏成功获取的关联分析：基于倾向性评分的回顾性队列研究[J/OL]. 中华移植杂志(电子版), 2025, 19(06): 414-420.

Peng Hao, Juejing Li, Huankun Ning, Xiaohong Qiu. Association between bronchoscopy frequency and successful lung procurement in potential brain-dead donors: a propensity score matching retrospective cohort study[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2025, 19(06): 414-420.

目的

探讨纤支镜操作频率与脑死亡潜在供者肺脏成功获取的关系，评估其对供肺质量的潜在影响及安全性，为优化供者维护策略提供科学依据。

方法

回顾性分析2020年1月至2024年1月在中山大学孙逸仙纪念医院ICU实施器官捐献的251例脑死亡潜在供者临床资料。根据住院期间纤支镜操作频率将脑死亡潜在供者分为低频率组(n＝131例)和高频率组(n＝120例)。采用倾向性评分匹配(PSM)并按照1 ∶1匹配原则对两组患者进行匹配，匹配后每组各包含77例患者。以本院人工智能大数据平台为基础，系统采集脑死亡潜在供者基线资料。正态分布计量资料组间比较采用独立样本t检验，非正态分布计量资料组间比较采用Mann-Whitney U检验；计数资料组间比较采用卡方检验或Fisher确切概率法。通过多变量Logistics回归模型、倾向性评分调整和加权模型分析纤支镜操作频率与肺脏成功获取的关系。P<0.05为差异具有统计学意义。

结果

PSM前低频率组和高频率组供肺成功获取率分别为30.5%(40/131)和41.7%(50/120)，匹配后低频率组和高频率组供肺成功获取率分别为28.6%(22/77)和42.9%(33/77)。PSM前纤支镜操作低频率组和高频率组供者基线资料差异较大，匹配后两组供者基线资料差异降低。粗略回归模型分析示高频率和低频率组供肺成功获取率差异无统计学意义(P>0.05)；多变量Logistics回归模型分析示高频率组供肺成功获取率高于低频率组(OR＝3.33，95%CI：1.66~6.67)，差异有统计学意义(P<0.05)；PSM的逻辑回归模模型(OR＝2.29，95%CI：1.27~4.15)、逆概率加权(OR＝2.18，95%CI：1.29~3.69)、标准化死亡率加权(OR＝2.13，95%CI：1.24~3.66)和分层加权(OR＝3.33，95%CI：1.66~6.67)模型分析示高频率组供肺成功获取率均高于低频率组，差异均有统计学意义(P均<0.05)。但PSM后高频率组与低频率组脑死亡潜在供者捐献前凝血和感染相关指标以及呼吸机参数差异均无统计学意义(P均>0.05)。

结论

较高频率的纤支镜操作与脑死亡潜在供者肺脏成功获取率的增加存在关联，同时未显著增加气道或全身并发症。

关键词: 脑死亡潜在供者, 纤支镜操作频率, 肺移植, 供肺获取, 机械通气参数, 凝血功能
Objective

To investigate the association between bronchoscopy frequency and successful lung procurement among potential brain-dead donors, and to evaluate its potential impact on donor lung quality and safety, with the aim of providing evidence to optimize donor management strategies.

Methods

A retrospective analysis was conducted on 251 potential brain-dead donors who underwent organ donation in the intensive care unit of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between January 2020 and January 2024. According to the frequency of bronchoscopic procedures performed during hospitalization, donors were divided into a low-frequency group (n=131) and a high-frequency group (n=120). Propensity score matching (PSM) was performed at a 1 ∶1 ratio, yielding 77 matched donors in each group. Baseline characteristics were systematically collected using the hospital′s artificial intelligence–based big data platform. Continuous variables with normal distribution were compared using independent-sample t tests, whereas non-normally distributed variables were compared using the Mann-Whitney U test. Categorical variables were compared using the chi-square test or Fisher′s exact test. Multivariable Logistic regression, propensity score-adjusted Logistic regression, and weighted models were applied to examine the association between bronchoscopy frequency and successful lung procurement. A P value <0.05 was considered statistically significant.

Results

Before PSM, the successful lung procurement rates were 30.5% (40/131) in the low-frequency group and 41.7% (50/120) in the high-frequency group. After PSM, the corresponding rates were 28.6% (22/77) and 42.9% (33/77), respectively. Substantial differences in baseline characteristics between the two groups were observed before matching, which were markedly reduced after PSM. In the unadjusted regression model, no statistically significant difference in successful lung procurement rate was observed between groups (P>0.05). However, multivariable Logistic regression analysis showed a significantly higher likelihood of successful lung procurement rate in the high-frequency group (OR=3.33, 95%CI: 1.66-6.67; P<0.05). Consistent results were obtained using propensity score-adjusted Logistic regression model (OR=2.29, 95%CI: 1.27-4.15), inverse probability weighting model (OR=2.18, 95%CI: 1.29-3.69), standardized mortality ratio weighting model (OR=2.13, 95%CI: 1.24-3.66), and stratified weighting model (OR=3.33, 95%CI: 1.66-6.67), all indicating significantly higher procurement success rates in the high-frequency group (all P<0.05). After PSM, no significant difference was observed between the two groups in pre-donation coagulation parameters, infection-related markers, or ventilator settings (all P>0.05).

Conclusion

A higher frequency of bronchoscopic procedures was associated with an increased rate of successful lung procurement among potential brain-dead donors, without a significant increase in airway-related or systemic complications.

Key words: Potential brain-dead donor, Bronchoscopy frequency, Lung transplantation, Donated lung procurement, Mechanical ventilation parameter, Coagulation function
图1 PSM前后纤支镜操作低频率组和高频率组倾向性评分分布核密度图注：a. PSM前倾向性评分分布；b~f.分别为经PSM(倾向性评分匹配)、IPTW(逆概率加权)、SMRW(标准化死亡率加权)、PA(分层加权)和OW(重叠加权)后；黑线.所有供者；红色和绿色细线.分别为未匹配时高频率和低频率组；红色和绿色粗线．分别为匹配后高频率和低频率组；线条重叠程度.反映匹配或加权后协变量平衡情况，重叠越多则协变量平衡性越好
表1 纤支镜操作低频率组与高频率组脑死亡潜在供者PSM前后基线资料差异比较
因素 匹配前 SMD值 匹配后 SMD值
低频率组(n＝131例) 高频率组(n＝120例) 低频率组(n＝77例) 高频率组(n＝77例)
性别(例，男/女) 101/30 102/18 0.20 64/13 65/12 0.04
年龄(岁，±s) 42.1±12.0 43.1±11.1 0.09 42.7±12.0 44.9±10.5 0.20
高血压[例(%)] 40(30.5) 31(25.8) 0.11 22(28.6) 23(29.9) 0.03
肝炎或肝硬化[例(%)] 3(2.3) 8(6.7) 0.21 3(3.9) 3(3.9) 0.01
肾衰竭[例(%)] 1(0.8) 4(3.3) 0.18 1(1.3) 2(2.6) 0.09
脑中风[例(%)] 4(3.1) 5(4.2) 0.06 2(2.6) 3(3.9) 0.07
冠心病或先心病[例(%)] 3(2.3) 2(1.7) 0.05 2(2.6) 1(1.3) 0.09
糖尿病[例(%)] 3(2.3) 2(1.7) 0.05 1(1.3) 2(2.6) 0.09
心肺复苏[例(%)] 13(9.9) 26(21.7) 0.33 9(11.7) 7(9.1) 0.09
APACHE Ⅱ(分，±s) 21.2±5.2 21.0±5.5 0.04 20.8±5.4 20.9±5.1 0.03
SOFA(分，±s) 10.6±3.2 11.6±3.2 0.32 10.9±3.1 10.9±2.5 0.03
心率(次/min，±s) 116.5±20.4 121.2±25.1 0.21 117.5±20.7 116.8±23.6 0.03
体温(℃，±s) 37.4±0.9 37.5±1.0 0.12 37.4±0.9 37.5±1.1 0.14
血氧饱和度(%，±s) 99.2±2.0 101.0±29.1 0.09 99.2±1.7 98.3±11.2 0.11
白细胞(109/L，±s) 15.5±6.4 13.8±7.2 0.24 14.9±6.5 14.5±7.3 0.07
血红蛋白(g/L，±s) 96.6±33.5 95.3±30.1 0.04 96.2±35.9 96.4±30.9 0.01
血小板[109/L，M(P25，P75)] 121.0(60.0，174.5) 112.0(58.0，184.2) 0.01 104.0(52.0，173.0) 115.0(65.0，195.0) 0.01
降钙素原[ng/mL，M(P25，P75)] 4.3(1.0，16.1) 4.9(1.3，20.7) 0.15 5.8(1.3，15.0) 3.2(1.1，12.8) 0.02
脑钠肽[pg/mL，M(P25，P75)] 857.7(276.0，1916.5) 956.0(235.2，2 607.5) 0.16 1045.0(309.0，2 315.0) 881.0(230.0，2 239.0) 0.09
肌酸激酶同工酶[U/L，M(P25，P75)] 36.0(19.5，55.8) 17.6(5.7，52.2) 0.19 30.5(14.0，55.8) 18.9(6.5，44.0) 0.11
血清肌酐[μmol/L，M(P25，P75)] 116.0(76.0，163.5) 116.0(87.0，187.5) 0.05 120.0(77.0，165.0) 112.0(88.0，154.0) 0.12
尿素氮[mmol/L，M(P25，P75)] 7.6(5.3，11.7) 8.2(5.4，12.4) 0.06 8.3(5.3，11.9) 8.1(5.2，11.4) 0.05
AST[U/L，M(P25，P75)] 73.0(39.0，158.5) 67.0(41.0，135.2) 0.25 84.0(43.0，154.0) 66.0(41.0，112.0) 0.29
总胆红素[μmol/L，M(P25，P75)] 19.0(12.9，24.8) 17.4(11.5，30.9) 0.09 19.6(14.2，26.3) 17.3(11.7，29.7)) 0.00
白蛋白(g/L，±s) 32.3±7.0 32.4±7.2 0.02 31.8±7.0 32.3±6.9 0.08
凝血酶原时间[s，M(P25，P75)] 13.9(12.5，15.7) 13.6(12.7，15.4) 0.03 14.1 (12.6，16.1) 13.3 (12.4，14.8) 0.01
APTT(s，±s) 31.7±14.6 33.6±14.3 0.13 32.9±17.7 32.4±15.7 0.03
ALT[U/L，M(P25，P75)] 39.0(22.5，93.0) 42.0(23.8，109.2) 0.31 51.0(25.0，115.0) 36.0(20.0，78.0) 0.22
D-二聚体[mg/L，M(P25，P75)] 8.2(4.5，19.2) 8.9(4.8，19.4) 0.07 8.2(4.9，18.6) 9.4(5.7，21.6) 0.23
pH值(±s) 7.38±0.10 7.38±0.10 0.08 7.37±0.10 7.37±0.09 0.06
二氧化碳分压(mmHg，±s) 39.4±10.5 41.5±10.8 0.20 41.8±11.4 41.4±10.3 0.03
动脉氧分压(mmHg，±s) 205.9±122.6 200.2±96.6 0.05 204.9±144.7 207.3±97.4 0.02
图2 纤支镜操作频率与脑死亡潜在供者供肺成功获取的关联分析注：IPTW.逆概率加权；SMRW.标准化死亡率加权；PA.分层加权；OW.重叠加权；OR.比值比；CI.置信区间
表2 高频率组与低频率组捐献前凝血和感染相关指标以及呼吸机参数比较
因素 高频率组(n＝77) 低频率组(n＝77) Z/t值 P值
INR[M(P25，P75)] 1.0 (1.0，1.1) 1.1 (1.0，1.2) 1.927 >0.05
APTT(s, ±s) 31.9±11.1 32.0±15.3 0.001 >0.05
血红蛋白(g/L, ±s) 84.7±24.2 84.4±22.1 0.009 >0.05
体温(℃，±s) 37.4±0.7 37.5±0.7 0.753 >0.05
白细胞(109/L, ±s) 17.8±10.6 15.3±9.9 2.325 >0.05
血清(1，3)-β-D葡聚糖(pg/mL, ±s) 44.6±11.9 44.1±15.0 0.048 >0.05
潮气量(mL, ±s) 458.0±38.0 457.5±47.5 0.006 >0.05
PEEP(mmHg, ±s) 5.8±1.5 6.1±1.8 0.710 >0.05
VIS[分，M(P25，P75)] 1.0(0.0，5.0) 0.5(0.0，5.0) 0.173 >0.05
呼吸机氧浓度(%, ±s) 57.9±13.7 60.5±16.1 1.230 >0.05
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