Current research status of pulmonary function assessment after hematopoietic stem cell transplantation in children

doi:10.3877/cma.j.issn.1673-5250.2025.06.002

Pulmonary complications subsequent to hematopoietic stem cell transplantation (HSCT) constitute a significant factor contributing to transplant-related morbidity and mortality among pediatric patients. Therefore, the early and accurate identification of pulmonary abnormalities is of paramount importance for improving prognosis of these post-HSCT children. As a non-invasive assessment tool, pulmonary function test (PFT) plays a pivotal role in monitoring pulmonary health, providing early warning for long-term complications such as pulmonary graft-versus-host disease (GVHD), and evaluating therapeutic responses in HSCT recipients. However, compared to the adult population, research on the longitudinal trajectory of pulmonary function in post-HSCT children is relatively limited, and the existing findings are inconsistent. Furthermore, the limitations of traditional PFT, the high demand for patient cooperation, have become increasingly apparent, which has spurred researchers to explore novel auxiliary diagnostic techniques including multiple-breath washout (MBW) test, forced oscillation technique, and parametric response mapping (PRM), to achieve more sensitive detection of early-stage lung injury. This review aims to systematically summarize the characteristics of pulmonary function changes in post-HSCT children, discuss the clinical utility and challenges of PFT in monitoring, and introduce recent advances in novel assessment methodologies, so as to provide a reference for clinicians to optimize pulmonary complications management strategies for pediatric HSCT recipients.

Key words: Hematopoietic stem cell transplantation, Respiratory function tests, Graft versus host disease, Clinical governance, Pulmonary complications, Hematologic neoplasms, Child

表1 目前国际上常用的HSCT后患儿肺功能异常诊断标准

异常类型	诊断参考指标	发生率	肺部并发症或原因
RVD	TLC<LLN	7%~50%	IPS、COP/BOOP、肺纤维化、胸壁和肺实质生长异常、化疗损伤
OVD	FEV1/FVC<LLN	0~24%	BO/BOS、支气管哮喘、肺和气管发育不良、含有肺毒性药物的预处理方案
DI	DLCO<LLN	15%~70%	肺部感染、细菌/真菌/病毒
VD	TLC、FEV1/FVC均<LLN	1%~2%	重度BOS、重症肺部感染、重度支气管哮喘

表1 目前国际上常用的HSCT后患儿肺功能异常诊断标准

异常类型	诊断参考指标	发生率	肺部并发症或原因
RVD	TLC<LLN	7%~50%	IPS、COP/BOOP、肺纤维化、胸壁和肺实质生长异常、化疗损伤
OVD	FEV1/FVC<LLN	0~24%	BO/BOS、支气管哮喘、肺和气管发育不良、含有肺毒性药物的预处理方案
DI	DLCO<LLN	15%~70%	肺部感染、细菌/真菌/病毒
VD	TLC、FEV1/FVC均<LLN	1%~2%	重度BOS、重症肺部感染、重度支气管哮喘

图1 HSCT患儿肺功能评估流程图注：HSCT为造血干细胞移植。PFT为肺功能测定。OVD为阻塞性通气功能障碍，RVD为限制性通气功能障碍，MVD为混合性通气功能障碍。BOS为闭塞性细支气管炎综合征，MBW为多次呼吸冲洗。DLCOadj为血红蛋白含量校正后的一氧化碳肺弥散量，FEV1为第一秒用力呼气容积。所有患儿应在HSCT前常规进行PFT，以确定HSCT前基线水平。对于DLCOadj>50%预测值患儿，根据原发疾病接受标准化预处理方案。对于40%预测值(某些方案允许为30%预测值)<DLCOadj≤50%预测值患儿，建议在预处理期间慎用肺毒性药物。^a在具有足够技术专长进行MBW测试的中心，建议使用HSCT后MBW测试作为疑似BOS诊断评估的一部分，作为肺活量测定的补充工具，或者在肺活量测定不可行的情况下单独使用

表2 HSCT后患儿的常用PFT方法及适用性对比

评估工具	检测方法适用范围	主要监测指标	异常结果提示
PFT	≥6岁配合度良好儿童	FEV1、FEV1/FVC、FVC、DLCO等	OVD、RVD、MVD、DI
IOS^[37]	≥3岁可被动配合儿童	Zrs、Rrs、Rrs5~20、Xrs、fres、AX	中央气道/小气道阻塞、通气非均一性
MBW测试^[38]	2~6岁学龄前儿童，对配合度要求低	LCI、Scond、Sacin	小气道功能异常、肺通气分布不均匀
PRM^[36]	≥5~6岁无法配合PFT的儿童(替代性结构-功能评价)	PRMNormal、PRMEmph、PRMfSAD、PRMPD	小气道功能障碍、肺实质疾病、肺气肿

表2 HSCT后患儿的常用PFT方法及适用性对比

评估工具	检测方法适用范围	主要监测指标	异常结果提示
PFT	≥6岁配合度良好儿童	FEV1、FEV1/FVC、FVC、DLCO等	OVD、RVD、MVD、DI
IOS^[37]	≥3岁可被动配合儿童	Zrs、Rrs、Rrs5~20、Xrs、fres、AX	中央气道/小气道阻塞、通气非均一性
MBW测试^[38]	2~6岁学龄前儿童，对配合度要求低	LCI、Scond、Sacin	小气道功能异常、肺通气分布不均匀
PRM^[36]	≥5~6岁无法配合PFT的儿童(替代性结构-功能评价)	PRMNormal、PRMEmph、PRMfSAD、PRMPD	小气道功能障碍、肺实质疾病、肺气肿

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