免疫球蛋白在肾移植后肺部感染治疗中的辅助作用

Intravenous immunoglobulin therapy in the pulmonary infection after renal transplantation

目的探讨静脉注射大剂量免疫球蛋白在肾移植后肺部感染治疗中的辅助作用.方法肾移植后发生肺部感染的14例患者,在常规针对病原体治疗基础上辅以静脉注射免疫球蛋白,其中8例给予大剂量免疫球蛋白(A组)7～10 d,6例接受小剂量免疫球蛋白组(B组)3～7 d;另有12例肾移植后发生肺部感染者仅接受针对病原体的治疗(C组).观察各组重症肺部感染发生率,A、B组治疗前后血清IgG、IgA、IgM的浓度以及T淋巴细胞亚群的变化.结果A、B、C组重症肺部感染发生率分别为0、66.7%和66.7%,死亡率为0、16.7%和25.0%;A组治疗后血清IgG浓度升高(P＜0.01),并明显高于B组(P＜0.01);A、B组治疗前后T淋巴细胞亚群的差异均无统计学意义(P＞0.05).结论早期联合静脉注射大剂量免疫球蛋白作为一种辅助治疗,能阻止肾移植后肺部感染的进一步发展,降低重症肺部感染的发生率和死亡率.

Objective To evaluate the adjunctive therapeutic effect of intravenous immunoglobulin (IVIG) therapy in the pulmonary infection after kidney transplantation.Methods In 14 cases of pulmonary infection after kidney transplantation, 8 and 6 cases were subjected to high dose (7 to 10 days, group A) or low dose (3 to 7 days, group B) of IVIG therapy besides the standard specific anti-pathogen therapy. In 12 cases of pulmonary infection after kidney transplantation, only standard specific anti-pathogen therapy was given (group C). The incidence and mortality of severe pulmonary infection, levels of serum IgG, IgA, IgM and T lymphocyte subsets among the three groups were observed.Results The incidence of severe pulmonary infection was 0, 66.7 % and 66.7 % respectively in groups A, B and C with the mortality being 0, 16.7 % and 25.0 % respectively. The level of serum IgG was significantly increased in group A after treatment as compared with that before treatment and in group B ( P < 0.01 ). There were no significant differences in T lymphocyte subsets in groups A and B before and after treatment ( P > 0.05 ).Conclusion As an adjunctive therapy, high dose of IVIG at early stage of pulmonary infection can reduce the incidence of severe pulmonary infection and mortality after kidney transplantation.