甲泼尼龙与醋酸泼尼松治疗肾移植术后肺部感染  

Prospective study of methylprednisolone and prednisone therapy for patients with pulmonary infection after renal transplantation

作　　者：王振璞 蒋欣[1] 苗书斋[1] 曲青山[1] 

机构地区：[1]郑州人民医院器官移植科,450003

出　　处：《实用医学杂志》2017年第1期22-26,共5页The Journal of Practical Medicine

摘　　要：目的:对比甲泼尼龙琥珀酸钠静脉滴注与醋酸泼尼松口服对肾移植后肺部感染的临床疗效。方法:纳入2013年1月至2016年1月接受治疗的肾移植后重症肺部感染患者136例为对象,采用随机数字表法均分为2组。均在常规综合治疗的基础上调整免疫抑制剂应用方案,观察组同时应用甲泼尼龙琥珀酸钠,对照组应用醋酸泼尼松。对比2组临床疗效,存活患者治疗期间体温、动脉血压分压随时间变化情况,存活患者治疗前后尿微量白蛋白/肌酐比值(ACR)、血清肌酐(Scr)、尿β2-微球蛋白变化情况。结果:观察组2例死亡、1例肾移植失功能;对照组2例死亡、3例肾移植失功能,2组临床疗效对比,差异无统计学意义(P>0.05)。观察组体温恢复正常时间明显短于对照组,且用药16 h后观察组体温即明显低于对照组,持续至用药4d,差异有统计学意义(P<0.05)。观察组动脉血氧分压恢复正常时间明显短于对照组,且用药2d后观察动脉血氧分压即明显高于对照组,持续至统计结束,差异有统计学意义(P<0.05)。存活患者中期ACR、Scr、尿β2-微球蛋白均明显上升(P<0.05),组间各时点差异无统计学意义(P>0.05)。结论:甲泼尼龙能够迅速改善肾移植术后肺部感染患者体温及血气指标,但对降低死亡率及肾移植失功率并无明显作用,对存活患者中期肾功能亦无明显影响。Objective To investigate the clinical efficacy of methylprednisolone intravenous infusion and to take oral prednisone for patients with pulmonary infection after renal transplantation. Methods One hundred and thirty-six patients with severe pulmonary infection after renal transplantation in our hospital from January 2013 to January 2016 were enrolled and randomly divided into 2 groups. All patients were treated with immunosuppressant adjustment based on the basis of routine treatment. Patients in the observation group were applied methylprednisolone, while patients in the control group were applied prednisone. The clinical efficacy between 2 groups were compared. The changes of body temperature, PaO2 during treatment in survivors of both 2 groups and the changes of ACR, Scr, urine β2-macroglobulin after treatment in survivors of both groups were compared. Results There were 2 cases died and 1 case of renal allograft dysfunction in the observation group. There were 2 cases died and 3 case of renal allograft dysfunction in the observation group. No significant difference in clinical efficacy was found between 2 groups （P 〉 0.05）. For survivors, the recovery time of body temperature in the observation group was significantly shorter than that in the control group. From 16 hours until 4 days after treatment, the body temperature in the observation group was significantly lower than that in the control group （P 〈 0.05）, the recovery time of PaO2 in the observation group was significantly shorter than that in the control group. From 2 days until the end of statistics after treatment, PaO2 in the observation group was significantly lower than that in the control group （P 〈 0.05）. ACR, Scr, urine 132-macroglobulin were significantly increased in all survivors （P 〈 0.05）. There were no significant differences between 2 groups at every time point （P 〉 0.05）. Conclusion Methylprednisolone can decrease body temperature and increase PaO2 in patients with pulmonary infection after renal transplan

关 键 词：甲泼尼龙琥珀酸钠 醋酸泼尼松 肾移植 重症肺炎 

分 类 号：R699.2[医药卫生—泌尿科学] R563.1[医药卫生—外科学]