肾移植术后肺部感染状态下免疫抑制剂的调整  

Adjustment of immunosuppressant in pulmonary infection following renal transplantation

作　　者：罗晓辉[1] 薛武军[1] 燕航[1] 田普训[1] 丁小明[1] 项和立[1] 李杨[1] 宋勇[1] 

机构地区：[1]西安交通大学医学院第一附属医院肾病中心肾移植科,710061

出　　处：《中华器官移植杂志》2010年第9期524-527,共4页Chinese Journal of Organ Transplantation

基　　金：陕西省＂13115＂科技创新工程重大科技专项计划（2007ZDKG-67）;国家自然科学基金（30772096,30972947）;卫生部临床学科重点项目（2007,2009年度）;国家973项目（2009CB522400）;陕西省自然科学基金（SJ08C201）

摘　　要：目的 探讨肾移植术后肺部感染患者免疫抑制剂的应用与预后的关系.方法 对肾移植术后合并肺部感染的98例患者临床资料进行回顾性分析.将患者分为维持应用免疫抑制剂组（维持剂量组,45例）与免疫抑制剂减量或停用组（调整剂量组,53例）.按与感染相关的器官衰竭估计评分（SOFA）标准,在肾移植术后肺部感染较重（SOFA≥12分）和感染较轻（SOFA＜12分）的情况下,分别分析两组患者的死亡率、感染恢复时间和排斥反应发生率的差异.结果 当SOFA≥12分时,调整剂量组死亡率和感染恢复时间明显低于维持剂量组（P＜0.05）,而排斥反应发生率在两组之间的差异则无统计学意义（P＞0.05）;当SOFA＜12分时,死亡率和感染恢复时间在两组之间差异无统计学意义（P＞0.05）,但调整剂量组患者排斥反应发生率明显高于维持剂量组（P＜0.05）.结论 在肾移植术后肺部感染较重（SOFA≥12分）时,减量和停用免疫抑制剂有利于降低患者的死亡率和缩短抗感染疗程;但感染较轻（SOFA＜12分）时,建议维持免疫抑制剂原剂量不变.Objective To explore the relationship between adjustment of immunosuppressant and prognosis in renal transplantation recipients with pulmonary infection. Methods The clinical data of 98 patients with pulmonary infection following renal transplantation were retrospectively analyzed.Patients were divided into two groups： conventional group （n = 45） and immunosuppressant adjustment group （n = 53）. The mortality, recovery time and rejection rate in two groups were analyzed under the statement of serious infection （SOFA≥12） and slight infection （SOFA＜ 12） by sequential organ failure assessment （SOFA） score. Results When the SOFA scores ≥ 12, the mortality and recovery time in immunosuppressant adjustment group were significantly lower than in conventional group （P＜0.05）, but there was no significant difference in the rejection rate between two groups （P＞0.05）. When the SOFA scores ＜11, there was no significant difference in mortality and recovery time between the two groups （P＞0.05）. The incidence of rejection in immunosuppressant adjustment group was significantly higher than in conventional group （P＜0.05）.Conclusion Mortality could be decreased and course of anti-infection treatment could also be shortened by adjusting the immunosuppressant in renal transplantation recipients with serious pulmonary infection （SOFA≥12）. Immunosuppressant agent was proposed to maintain the original treatment protocol when the infection was slight （SOFA＜12）.

关 键 词：肾移植 肺部感染 免疫抑制剂 

分 类 号：R699[医药卫生—泌尿科学] R563.1[医药卫生—外科学]