儿童肾移植受者再感染新型冠状病毒的诊疗经验

Diagnosis and treatment of reinfection of SARS-CoV-2 in kidney transplant recipients in children

目的探讨儿童肾移植受者再感染新型冠状病毒(SARS-CoV-2)的临床特点。方法回顾性分析2006年3月10日至2023年7月1日于郑州大学第一附属医院进行肾移植并感染SARS-CoV-2的191例儿童受者的临床资料。根据是否SARS-CoV-2再感染,将受者分为单次感染组(A组,127例)与重复感染组(B组,64例)。收集两组受者的基线资料、临床症状、诊疗策略、预测疾病进展的标志物、免疫状况、呼吸支持方式、合并症及移植相关数据,分别比较首次感染时两组受者之间的差异,以及重复感染组受者两次感染之间的差异。结果本研究共纳入191例儿童肾移植受者,单次感染组127例,重复感染组64例。相较于A组,B组受者首次感染时年龄<12岁(71.9%比54.3%)、未接种疫苗的比例(81.2%比66.1%)较高,出现高热(34.4%比12.6%)、干咳(43.8%比23.6%)、胸闷(14.1%比3.9%)等症状的比例较高(均P<0.05)。首次感染时,B组受者的IL-6及CRP水平高于A组,差异有统计学意义(均P<0.01)。B组受者再感染时的IL-6(P<0.01)、C反应蛋白(CRP)(P<0.01)及降钙素原(PCT)(P=0.023)水平较其首次感染时降低,差异有统计学意义。首次感染时,B组受者的CD3^(+)、CD4^(+)、CD8^(+)、NK及B淋巴细胞计数水平均低于A组,组间差异均有统计学意义(均P<0.01)。B组受者再感染时的CD3^(+)、CD4^(+)、CD8^(+)、NK及B淋巴细胞计数水平较其首次感染时增大,差异均有统计学意义(均P<0.01)。B组受者肌酐、尿素氮和尿酸的水平在首次感染前后的差异无统计学意义,而再感染前后的肌酐和尿酸的差异有统计学意义(均P<0.01)。结论首次感染SARS-CoV-2时症状明显的儿童肾移植受者更容易在后续的疾病流行期间发生再感染。儿童肾移植受者再感染时症状轻,但可加重移植肾功能损伤。

ObjectiveTo explore the clinical characteristics of pediatric kidney transplant recipients reinfected with SARS-CoV-2.MethodThe relevant clinical data were retrospectively reviewed for 191 pediatric kidney transplant recipients at a single center.Based upon whether or not there was a reinfection of SARS-CoV-2,they were assigned into two groups of single infection(group A,127 cases)and reinfection(group B,64 cases).Baseline profiles,clinical symptoms,diagnostic and therapeutic strategies,markers of disease progression,immune status,respiratory support modalities,comorbidities and transplantation-related data were collected for comparing the inter-group differences during primary infection and between two infections in reinfected group.ResultAs compared with group A,group B recipients had a higher proportion of age<12 years(71.9%vs 54.3%),unvaccinated(81.2%vs 66.1%)and such symptoms as high fever(34.4%vs 12.6%),dry cough(43.8%vs 23.6%)and chest tightness(14.1%vs 3.9%)during primary infection(all P<0.05).During primary infection,the levels of IL-6 and CRP were higher in group B than in group A and inter-group difference was statistically significant(both P<0.01).The levels of IL-6(P<0.01),CRP(P<0.01)and PCT(P=0.023)were lower in group B during reinfection than those during primary infection and the difference was statistically significant.During primary infection,the counts of CD3^(+),CD4^(+),CD8^(+),NK and B lymphocyte of group B were lower than those of group A.And inter-group differences were statistically significant(all P<0.01).During reinfection,the levels of CD3^(+),CD4^(+),CD8^(+),NK and B lymphocyte counts of group B spiked as compared with those of group A during primary infection and the differences were statistically significant(all P<0.01).The levels of SCr and UA in group B differed insignificantly before and after primary infection with SARS-CoV-2.However,the differences before and after reinfection were statistically significant(both P<0.01).ConclusionSymptomatic and immunocompromised pediatric KT recipients during primary infection with SARS-CoV-2 are more prone to reinfection during subsequent epidemics.Though mildly symptomatic,reinfection may exacerbate impairments of graft kidney function in pediatric KT recipients.