胸腺素对肾移植术后巨细胞病毒肺炎患者的免疫调节作用  

Immunoregulatory effect of Thymosin α1 on cytomegalovirus infection with ARDS after renal transplantation

作　　者：季曙明[1] 黎磊石[1] 孙启全[1] 沙国柱[1] 文吉秋[1] 程震[1] 程东瑞[1] 陈劲松[1] 刘志红[1] 

机构地区：[1]南京军区南京总医院南京大学医学院临床学院解放军肾脏病研究所,江苏南京210002

出　　处：《医学研究生学报》2009年第4期402-406,共5页Journal of Medical Postgraduates

摘　　要：目的:胸腺肽α1(日达仙)是一种生物应答调节剂,它在调节和增强机体免疫方面发挥重要作用。目前,胸腺肽α1已广泛应用于慢性肝炎和肿瘤患者的治疗,获得良好效果。但是,在肾移植术后免疫功能低下并发巨细胞病毒(CMV)肺炎的患者中应用胸腺肽α1尚未见报道。文中探讨胸腺素(日达仙)对肾移植术后并发巨细胞病毒(CMV)肺炎患者的免疫调节作用。方法:一旦患者确诊为急性呼吸衰竭和全身炎症反应综合征,全部经过呼吸机辅助呼吸和连续性血液净化(CBP)治疗过渡。所有患者均采用同样的免疫抑制剂调整方案和针对性抗病毒、细菌或抗真菌和支持治疗。将入选研究的患者随机分为胸腺素治疗组(治疗组,n=31)和未用胸腺素治疗组(对照组,n=28)。治疗组加用胸腺素1.6mg,皮下注射,隔日1次或每日1次。临床观察其抢救成功率、死亡率和移植肾有无急性排斥反应。动态观察外周血白细胞、淋巴细胞、T淋巴细胞亚群水平的变化。结果:胸腺素治疗组的抢救成功率明显高于对照组,分别为80.6%和53.6%(P<0.05);死亡率明显低于对照组,分别为19.4%和46.4%(P<0.05);CD4+T淋巴细胞、CD4+/CD8+T淋巴细胞比值较治疗前明显升高(P<0.05)。死亡患者死亡时肾功能均正常。存活患者因在抢救过程中撤减免疫抑制药物,发生急性排斥反应3例(治疗组2例和对照组1例)。随访观察12个月后,存活患者血肌酐均稳定正常(89.3±14.1)μmol/L。随着病程的变化,存活患者于治疗7、14和21 d时,外周血CD4+、CD8+T淋巴细胞计数逐渐升高,明显高于用药当日,其中CD4+T淋巴细胞上升更加明显,CD4+/CD8+比值亦升高。死亡组患者的CD4+、CD8+T淋巴细胞计数则呈进行性下降,治疗7、14和21 d时的CD4+T细胞亚群的计数明显低于存活组。结论:肾移植术后合并CMV肺炎患者加用胸腺素可调节T淋巴细胞数量、功能,增加T细胞活性,提高机体细胞免�Objective： Thymosinα1（Tα1,Zadaxin）,as a biological response modifier,plays a vital role in regulating and enhancing immunity.It has been widely used to treat a wide range of diseases including chronic hepatitis B and C and a variety of cancers.We aimed at investigate the regulatory effect of thymosin α1 on cytomegalovirus infection（CMV） with acute respiratory distress syndrome（ARDS） after renal transplantation.Methods： We divided 59 cases of CMV with ARDS after renal transplantation into a thymosin group（n = 31） and a control group（n = 28）.All the patients received the same rescue therapy.Suitable antiviral（Ganciclovir at 5 mg/kg every 12 h intravenously）,antibacterial or antifungal therapy was given if needed.In addition,the thymosin group received thymosin α 1 at 1.6 mg subcutaneously every 2 days or every day.Results： The success rate of the rescue treatment was significantly higher,but the death rate obviously lower in the thymosin than in the control group（80.7% vs斜体 53.6% and 19.4% vs斜体 46.4%）.The thymosin group showed a significant increase in CD4＋ lymphocytes and in the ratio of CD4＋/CD8＋ T lymphocyte subsets on day 14.And the survivors exhibited significantly increased counts of CD4＋ and CD8＋ lymphocytes on day 7,14 and 21,as compared with those on admission.Conclusion： Thymosin α1 significantly promoted CD4＋ and CD8＋ lymphocytes in producing immunity related cellular factors in cytomegalovirus pneumonia.Treatment with thymosin α1 could successfully reconstruct and repair cellular immunity,reinforce resistance to CMV infection,block vicious cycle of infection and respiratory failure and reduce death rate.

关 键 词：肾移植 巨细胞病毒肺炎 胸腺素(日达仙) 治疗 

分 类 号：R699.2[医药卫生—泌尿科学]