大剂量免疫球蛋白预防肾移植术后肺部感染:随机对照

High-dosage immunoglobin for preventing pneumonia following kidney transplantation: Randomized controlled trial

目的:肾移植术后半年内发生的并发症主要为感染,尤以肺部感染为重。静脉注射大剂量免疫球蛋白预防肾移植术后早期肺部感染的效果值得临床应用中予以总结提高。方法:①实验对象及分组:选择2002-01/2006-12于海南省人民医院肾内科就诊的肾移植术后半年内患者40例,对实验及治疗方案均知情同意,且得到医院伦理道德委员会批准。按随机数字表法分为2组,免疫球蛋白组、对照组各20例。②实验分组:免疫球蛋白组在应用免疫抑制剂基础上用0.4g/(kg·d)免疫球蛋白治疗;对照组应用免疫抑制剂。③实验评估:观察两组患者普通肺炎、重症肺炎发生率及血清IgG和T淋巴细胞亚群水平变化。结果:40例患者全部进入结果分析。①免疫球蛋白组患者的普通肺炎感染率及重症肺炎感染率均低于对照组(P<0.01)。②免疫球蛋白组患者血IgG、T淋巴细胞亚群CD3+,CD4+,CD8+水平均高于对照组(P<0.05),用免疫球蛋白治疗未见副作用。结论:随机对照结果显示,肾移植术后早期应用大剂量免疫球蛋白能明显减少肺部感染发生,减少并发症,提高肾移植患者生存率。

AIM: The complications within 6 months after kidney transplantation are mainly infection, especially pulmonary infection. This study investigated the therapeutic effects of treatment with high dosage immunoglobin after kidney transplantation by intravenous injection on preventing the pneumonia in early stage. METHODS: ①Forty patients who had undergone kidney transplantations in 6 months were collected from Department of Nephropathy in Hainan Provincial People's Hospital between January 2002 and December 2006, and were randomly divided into therapy group and control group, with 20 patients in each. Informed consents of experiment and treatment were obtained from all patients, and the experiments were approved by the hospital ethical committee.②Therapy group received 0.4 g/kg immunoglobin except for normal immunity inhibitor therapy everyday, while control group was treated with routine immunosuppressor.③The incidence rate of classic pneumonia and severe pneumonia in the two groups were measured respectively, and the change of serum IgG and T lymphocyte subsets were observed. RESULTS: Forty patients were all involved in the result analysis.①In therapy group, the incidence rates of classic pneumonia and severe pneumonia were lower than those in control group (P < 0.01).②The levels of serum IgG and T lymphocyte subsets (CD3+, CD4+, CD8+) were obviously increased in therapy group as contrasting to control group (P < 0.05). No side effect occurred in the therapy group. CONCLUSION: The results of randomized controlled trial reveal that, therapy with high dosage immunoglobin in early stage of post-kidney transplantation can significantly prevent the pneumonia and neopathy, furthermore improve the survival rate of patients after kidney transplantation.