肾移植术后肺部感染对移植肾功能影响的初步观察

Observation of the effect of pulmonary infection after kidney transplantation on kidney function

目的探讨肾移植术后患者肺部感染对移植肾功能的影响及可能原因。方法对肾移植术后出现肺部感染的89例患者,根据美国胸科协会(ATS)标准,分为重度肺部感染组37例和轻度肺部感染组52例;选取50例未发生感染的肾移植术后患者作为对照组。对重度肺部感染患者采取降阶梯治疗方案,轻度肺部感染患者则不采取此方案。观察两组感染患者治疗时免疫抑制剂的调整情况,治疗前和临床痊愈后1周、6个月、1年、3年时,患者的尿微量白蛋白/肌酐比值(ACR)、血清肌酐(Scr)以及尿β2-微球蛋白水平。并观察对照组患者的各项指标。结果重度感染组中大部分患者均减少或停用免疫抑制剂、应用静脉注射免疫球蛋白及白蛋白,轻度感染组中仅有部分患者采取这些措施。治疗前两组患者的各项指标差异无统计学意义。临床痊愈1周后,重度感染组患者ACR高于轻度感染组(P<0.05);两组间Scr差异无统计学意义(P>0.05)。痊愈后6个月、1年、3年重度感染组ACR及Scr均高于轻度感染组,差异有统计学意义(P<0.05);轻度感染组ACR及Scr均高于对照组,但差异无统计学意义(P>0.05)。重度感染组在感染时和痊愈后1周的尿β2-微球蛋白与轻度感染组比较,差异无统计学意义(P>0.05);痊愈后6个月、1年、3年重度感染组高于轻度感染组,差异有统计学意义(P<0.05);轻度感染组与对照组尿β2-微球蛋白比较,差异无统计学意义(P>0.05)。结论肾移植术后重度肺部感染可通过多种因素影响患者的肾功能。在治疗感染的同时,应采取措施以减少尿蛋白、保护肾功能。

Objective To investigate the effect of pulmonary infection after kidney transplantation on kidney function and the possible mechanisms.Methods A total of 89 patients with pulmonary infection after kidney transplantation were divided into severe group （37 cases） and mild group （52 cases） according to the definition of ATS;and 50 patients without infection after kidney transplantation were selected as control group.De-escalation therapy was performed on the patients in severe group,while patients in mild group did not receive this therapy.The regulation of immunosuppressants,urine micro albumin creatinine ratio and Scr of the patients before treatment,1 week,6 months,1 year and 3 years after recovery,as well as the urine β2-microglobulin,were documented.And the parameters in the control group were documented also.Results In the severe group,most of the patients reduced or discontinued immunosuppressants,with administration of IVIG and albumin;only a part of the patients in the mild group received these measures.Before the treatment,there was no significant difference between the groups.One week after recovery,ACR level in the severe group was higher than the mild group （P〈0.05）;and there was no significant difference in Scr （P〉0.05）.Six months after,ACR and Scr levels in severe group were higher than the mild group （P〈0.05）.There was no significant difference between the mild group and control group.As to the level of urine β2-microglobulin,there was no significant difference between the severe and mild groups （P〉0.05） at the time of infection and 1 week after recovery;but six months after recovery,the level of urine β2-microglobulin in severe group was higher than mild group,with a significant difference （P〈0.05）.There was no significant difference between mild group and control group （P〉0.05）.Conclusions The severe pulmonary infection after kidney transplantation could influences the kidney function by a variety of factors.Appropriate measures should be undertaken to reduce urine protein and protect kidney function when the patients with pulmonary infection are treated.