细胞免疫功能测定在肝移植术后早期真菌感染防治中的应用  

Role of the cellular immunology function test in preventing and treating the fungal infection following liver transplantation

作　　者：李瑞东[1] 殷浩[1] 傅宏[1] 王正昕[1] 马钧[1] 

机构地区：[1]第二军医大学附属长征医院器官移植科,上海200003

出　　处：《中华器官移植杂志》2010年第5期287-291,共5页Chinese Journal of Organ Transplantation

基　　金：基金项目：上海市科委科研计划项目课题（08410701100）

摘　　要：目的探讨细胞免疫功能监测在肝移植术后早期真菌感染防治中的应用。方法对2004年1月至2010年1月间所施行的679例尸体肝移植的临床资料进行回顾性分析，受者术后均采用他克莫司（Tac）＋吗替麦考酚酯＋泼尼松预防排斥反应。根据真菌感染防治方案不同将679例分为3组，A组：常规经验防治，共394例，所有受者术后常规使用氟康唑2周；B组：结合T淋巴细胞亚群计数防治，共151例，术后1周时，CD4＋T淋巴细胞计数〈100×10^6／L，CD4＋细胞／CD8＋细胞比值〈1．0的受者，维持血Tac浓度在较低水平，给予氟康唑口服2周；C组：根据T淋巴细胞亚群计数、CD4＋细胞／CD8＋细胞比值和CD4＋T淋巴细胞ATP值进行个体化防治，共134例。分析各组真菌感染发生率、病死率、急性排斥反应发生情况以及真菌感染与细胞免疫功能的关系。结果A、B、C组真菌感染发生率依次下降，分别为28．9％、21．2％和19．4％，差异有统计学意义（P〈0．05），病死率分别为16．7％、12．5％和3．8％，虽呈下降趋势，但差异无统计学意义（P〉0．05），急性排斥反应发生率依次下降，分别为28．4％、17．2％和13．4％，差异有统计学意义（P〈0.01）。B、C组真菌感染病例CD4＋T淋巴细胞计数为（147±43）×10^6／L；计数〈100×10^6／L的受者病死率高达50．0％，计数为（100-200）×10^6／L者的病死率为2．4％（1／41），二者间的差异有统计学意义（P〈0．05）。CD4＋T淋巴细胞计数与ATP值间无线性相关关系，真菌感染病例的ATP值为（117±61）μg／L。结论根据T淋巴细胞亚群计数和CD4＋T淋巴细胞ATP值量化评估肝移植受者细胞免疫功能，进行个体化免疫调节，制定个体化真菌感染防治方案，是减少肝移植术后早期真菌感染，降低真菌感染病死率的有效方法。Objective To explore the role of monitoring the cellular immune function in preventing and treating the fungal infection in the recipients of liver transplantation. Methods 679 cadaveric liver transplantations （from Jan. 2004 to Jan. 2010） were retrospectively studied. All the cases were divided into 3 groups according to different treatments and preventing regimens. The patients in groups A, B, C were treated based on the clinical experiences （394 cases）, T lymphocyte subsets counting （151 cases）, and combination of ATP values of CD4＋ T cell and T lymphocyte subsets counting （134 cases）, respectively. The infection, mortality and acute rejection rate were analyzed. The relationship between fungal infection and cellular immune function was investigated. Results The fungal infectionrate in groups A, B, and C was 28. 9 %, 21.2 %, and 19. 4 % （P〈 0. 05）, the morbidity rate was 16. 7 %, 12. 5 %, and 3. 8 % （P〉0. 05）, and the acute rejection rate was 28. 4 %, 17. 2 %, and 13. 4 % （P〈0. 01）, respectively. The CD4＋ T lymphocyte counting in all cases of fungal infection was （147 ±43） ×10^6/L. The morbidity could reach 50. 0 % when the CD4＋ T lymphocyte counting 〈100 ×10^6/L, while it was 2. 4 % when the counting was between （100-200）×10^6/L （P〈0. 01）. The CD4＋ T lymphocyte counting had no linear relation with the ATP value. The ATP value in fungal infection cases was （117 ± 61）μg/L. Conclusion The cellular immunefunction test could be quantitatively evaluated according to the T lymphocyte subsets and ATP value of CD4＋ T lymphocyte. And individualized immunosuppressive therapy could he adjusted accordingly. Therefore, cellular immune function could be instructive in preventing and treating the fungal infection after liver transplantation.

关 键 词：肝移植 免疫 细胞 真菌 感染 

分 类 号：R657.3[医药卫生—外科学]