肾移植术后间质性肺炎:24例对比分析

Interstitial pneumonia following renal transplantation:Comparative analysis in 24 cases

目的:探讨肾移植术后间质性肺炎的早期诊断和处理原则。方法:选择吉林大学第一临床医院器官移植中心2006-04/2007-03及2007-04/12两个时期肾移植术后患者出现间质性肺炎患者24例。根据时间分为2组,2006年组12例CMV-IgM阴性、CMV-IgG阳性,4例CMV-IgM、CMV-IgG均阴性。2007年组6例CMV-IgM阴性、CMV-IgG阳性,2例CMV-IgM、CMV-IgG均阴性。两组移植后常规静脉注射或口服更昔洛韦。检查肺CT,对肺CT有改变者,2006年组根据血药浓度调整免疫抑制剂用量;2007年组采取减少或停用免疫抑制剂,使用糖皮质激素、抗病毒及复方新诺明治疗。比较两组患者治愈率、死亡率、排斥反应发生率。结果:2006年组16例患者中11例痊愈,5例死亡。2007年组8例患者均治愈,两组患者均未发生急性排斥反应。结论:肾移植后临床表现及CT检查是早期诊断的关键。早期调整免疫抑制剂用量、使用糖皮质激素、抗巨细胞病毒治疗、联合应用复方新诺明及有效的营养支持均是治疗肾移植术后间质性肺炎的有力措施。

OBJECTIVE：To study the early diagnosis and management of the patients with interstitial pneumonia following renal transplantation.METHODS：Totally 24 patients with interstitial pneumonia following renal transplantation within the periods of April 2006 to March 2007,and April 2007 to December 2007 were selected.All patients were divided into 2 groups according to time points.The year 2006 group including 12 patients with CMV-IgM-,CMV-IgG＋,and 4 patients with CMV-IgM-,CMV-IgG-.The year 2007 group comprise 6 cases with CMV-IgM-,CMV-IgG＋,and 2 patients with CMV-IgM-,CMV-IgG-.Ganciclovir were intravenous injected or take orally after renal transplantation.To patients who had changes in pulmonary CT,dosage of immunosuppressive agent were regulated according blood drug level in the year 2006 group,and immunosuppressive agent was reduced or replaced with glucocorticoid,antibiotics and bactrim in the year 2007 group.The cure rate,death rate,as well as acute rejection rate were compared between two groups.RESULTS：There were 11 patients recovered and 5 died in the year 2006 group,while,8 patients all recovered in the year 2007 group.No acute rejection occurred in both groups.CONCLUSION：The clinical situation and CT scan play a key role in early diagnosis of interstitial pneumonia.Adjustment of immunosupressive agents at early time,administration with glucocorticoid and antiviral drugs,combined with bactrim and effective nutritional support are important for the treatment of patients with interstitial pneumonia following renal transplantation.