两种免疫抑制方案肾移植患者感染的调查

Infection among Renal Transplant Recipients Using Two Dfferent Immunosuppressive Schemes:A Comparitive Study

目的比较以硫唑嘌呤(AZA)或吗替麦考酚酯(MMF)为基础的两种免疫抑制方案,对肾移植术后感染的影响,并探讨肺部感染与尿路感染的病原学分布。方法收集两组肾移植患者249例:AZA组(应用AZA+环孢素A+激素)与MMF组(MMF+环孢素A+激素),统计两组患者在术后1年内各种感染的发生情况,并分析肺部感染与尿路感染的病原学分布。结果AZA组与MMF组术后1年总的感染率以及肺部感染、尿路感染、伤口感染等的发生率相近,以肺部感染与尿路感染最常见,但发生急性呼吸窘迫综合征(ARDS)及肺部感染死亡率后者明显高于前者;两组肺部感染病原学方面有一定差异,MMF组巨细胞病毒及真菌感染率增加;尿路感染病原体分布也存在一定的差异:两组均以革兰阴性菌多见,但MMF组的革兰阳性菌及真菌感染率明显高于AZA组。结论MMF组增加重症肺部感染机会,且病原学分布与AZA组存在差异,普通性细菌感染比例下降,而真菌、病毒及一些少见病原微生物感染的概率增加,故临床用药应个体化、有针对性。

OBJECTIVE To compare mycophenolate mofetil （MMF） with azathioprine （AZA） addition to ciclosporin-prednisone protocol after kidney transplantation in aspect of infections, and to study the etiology of pulmonary infection and urinary tract infection in the two groups. METHODS Totally 249 patients with kidney transplantation were analyzed retrospectively. These patients were divided into two groups according to the immunosuppressive regiment AZA group （89 patients ）, and MMF group （160 patients）. The various infectious complications were analyzed during a 1-year follow-up, and the etiology of pulmonary infection and urinary tract infection was studied in the two groups. RESULTS The total incidence of the infections, the incidences of the pulmonary infection, urinary tract infecion, wound infection, and so on, during a 1-year follow-up, were equivalent between the two groups. But the incidence of ARDS and the mortality of patients with lung infection was significantly different. The etiology of pulmonary infection was different between the two groups. Cytomegalovirous and fungal infections were higher in MMF group than those in AZA group. Also the etiology of urinary tract infection was different, the incidences of Gram-positive bacterial and fungal infections were higher in MMF group than those in AZA group. CONCLUSIONS Comparing with AZA, MMF increased the opportunity of serious lung infection. The incidences of opportunistic infection and fungal and viral infections increased obviously in MMF group. So therapy should be individualized and aimed.