免疫抑制剂在肾移植术后肺部感染中的应用

Immunosuppressive agents in the treatment of pulmonary infection following renal transplantation

目的:肾移植术后肺部感染治疗难度较大,如何有效的保护或者替代移植肾功能,又不能使患者的机体免疫状态极度低下,免疫抑制剂的调整使用至关重要。文章旨在探讨肾移植术后肺部感染患者免疫抑制剂的应用方案。方法:选择解放军空军总医院2002-01/2006-12收治的同种异体肾移植术后肺部感染患者20例,其中重症肺部感染13例。症状较轻的患者,给予免疫抑制剂调整及减量、抗感染等综合治疗;重症肺部感染立即停用所有免疫抑制剂,给予抗感染治疗,并根据肺部感染治疗效果,逐渐加用常规免疫抑制剂。观察20例肾移植术后肺部感染病例的治疗转归。结果:7例症状较轻的患者全部治愈。13例重症肺部感染患者中治愈9例,死亡2例,放弃治疗2例,治愈的9例中仅有1例发生移植肾急性排斥反应1次,经抗胸腺细胞球蛋白治疗逆转。治愈病例移植肾功能正常。结论:早期诊断、及时治疗并调整免疫抑制剂方案有利于提高肾移植术后肺部感染的治愈率。

AIM：It is difficult to treat the pulmonary infection following renal transplantation, so the application of immunosuppressive agent is critical to protect or substitute grafted kidney function, and prevent low immune state. This study investigated the application protocol of immunosuppressive agents during the treatment of pulmonary infection in renal transplantation patients. METHODS： Twenty patients with pulmonary infection after renal transplantation were selected from the General Hospital of Air Force of Chinese PLA between January 2002 and December 2006. The patients with lighter symptoms were given the therapy of immunosuppressive agent regulation or decrement, and anti-infection, but the patients with severe pulmonary infection （n=13） stopped using any immunosuppressive agent and treated with anti-infective therapy. Then the immunosuppressive agent was adopted if the pulmonary infection was improved. The treatment outcome of 20 cases was observed. RESULTS： Seven cases of lighter pulmonary infection all recovered. Of the 13 cases with severe pulmonary infection, 2 died, 2 gave up the treatment, and 9 recovered, in which 1 case developed acute rejection once after transplantation and reversed by antithymocyte globulin therapy. The function of transplanted kidney of the living cases was normal. CONCLUSION： Early diagnosis, prompt treatment and modulation of immunosuppressive agents can help to elevate the cure rate of pulmonary infection following renal transplantation.