免疫抑制方案调整对肾移植术后重症肺炎患者血清胱抑素C浓度影响的研究

The research of effect of immunosuppressive regimen adjustment on the serum Cystatin C concentration in patients with severe pneumonia after renal transplantation

目的探讨肾移植术后重症肺部感染患者免疫抑制方案调整前后SCys C的变化,以期为临床提供一个简便、准确、敏感地反映移植肾功能的指标。方法纳入我院收治的17例肾移植术后重症肺部感染患者,胶乳增强免疫透射比浊法(Modular P全自动生化分析仪,德国Roche公司)测定免疫抑制方案调整前后血清胱抑素C(Serum CystatinC,SCys C)浓度。结果 17例重症肺部感染患者治疗过程中,7例停用免疫抑制剂,仅使用甲强龙40mg静滴,免疫抑制剂停用时间为7～20天;8例免疫抑制剂用量减少。免疫抑制剂减量或停用期间,无患者发生排斥反应。调整免疫抑制剂前后肾移植术后重症肺炎患者SCys C水平分别为(2.02±0.99)mg/L、(2.21±1.12)mg/L(P=0.053)。结论调整免疫抑制方案前后肾移植术后重症肺炎患者SCys C水平变化无统计学意义,提示重症感染发生时,及时调整免疫抑制剂用量为有效且安全的治疗措施。SCys C可作为评估肾移植术后感染患者移植肾功能的监测指标。

Objective The serum Cystatin C concentration changes in patients with severe pneumonia after renal transplantation were investigated when immunosuppressive regimen were adjusted in order to provide a simple, accurate, sensitive marker to assess allograft function. Methods 17 subjects with severe pneumonia after renal transplantation were rolled in patients admitted to West China Hospital of Sichuan University from Jan 2010 to Jan 2012. The serum Cystatin C concentration were tested by latex enhanced immune transmission turbidimetric method （Modular P automatic biochemical analyzer, Germany Roche Company） before and after adjustment of immune suppression regimen. Results The immunosuppressants were forbidden in 7 cases for 7.20 days only with intravenous methylprednisolone 40mg, and the dosage was reduced in 8 cases. During the reduction or the forbidden period of immunosuppressants, no rejection occurred in patients. The Cystatin C levels were （2. 02±0.99） mg/L and （2.21±1.12） mg/L （P=0. 053）before and after the adjustment of immune suppression regimen, respectively. Conclusion No significant difference was found of the Cystatin C level changes before and after adjustment of immunosuppressants regimen. And the immunosuppressants dosage adjusted timely may be an effective and safe treatment when severe infection occurs. The serum Cystatin C can be used to monitor renal function of patients with infection after transplantation.