摘要
目的探讨肾上腺皮质激素(激素)在治疗肾移植术后肺部感染中的应用价值。方法收集2008年1月至2012年6月解放军第281医院肾移植中心收治的78例肾移植术后肺部感染患者的临床资料,所有患者均签署知情同意书,符合医学伦理学规定。肺部感染发生于肾移植术后2～6个月52例,7～18个月15例,18个月以后11例。其中单纯巨细胞病毒(CMV)感染24例,单纯细菌性感染17例,混合性感染28例,病原体不明感染9例。根据患者情况,予调整或停用免疫抑制剂,应用激素及针对病原学进行抗感染治疗,其后根据患者临床症状及肺部计算机断层摄影术(CT)表现,激素逐渐减量。同时予钙剂预防骨质疏松,予抗凝及调脂药物预防血栓形成,予抑酸剂预防消化道溃疡的发生。结果 78例患者中,治愈73例,死亡3例,并发脑出血放弃治疗1例,转院1例。3例死亡病例中,2例死于多器官功能衰竭,1例死于急性呼吸衰竭。2例患者发生急性排斥反应,其中1例患者免疫抑制方案改为抗人T细胞免疫球蛋白(ALG)+MMF+FK506+甲泼尼龙治疗,另1例通过血液透析过渡,免疫抑制方案改为MMF+FK506+甲泼尼龙治疗,均得以成功逆转。发生下肢静脉血栓2例,脑血栓2例,予对症治疗后好转。结论肾移植术后肺部感染的治疗,应在调整免疫抑制剂方案和抗感染治疗的同时配合激素治疗,可取得良好的治疗效果。
Objective To investigate the application value of adrenocortical hormone in treatment of pulmonary infection after renal transplantation. Methods Clinical data of 78 patients with pulmonary infection after renal transplantation in the Renal Transplantation Center of the PLA 281 Hospital from January 2008 to June 2012 were collected. This study was approved by local ethical committee and the informed consent of all participating subjects was obtained. Fifty-two patients developed pulmonary infection in 2- 6 months after renal transplantation, while 15 patients developed in 7-18 months and 11 patients developed over 18 months. Among them, 24 cases suffered from cytomegalovirus （CMV） , 17 suffered from bacterial infection, 28 suffered from mixed infection and 9 had unknown pathogen infection. The dosage of immunosuppressive agents were adjusted or stopped according to the condition of patients. Adrenocortical hormone and antibiotics according to pathogen were used to treat the infection. Then the dosage of adrenocortical hormone was reduced gradually according to the clinical symptoms and computed tomography （CT） results of the patients. Calcium was used to prevent osteoporosis, anticoagulant and hypolipidemic were used to prevent thrombosis and antacid were used to prevent gastrointestinal ulceration. Results Among 78 patients, 73 cases were cured, 3 cases died, 1 ease gave up treatment due to cerebral hemorrhage and 1 case was transferred to other hospital. Two of the 3 death cases died of multiple organ failure and the other one died of acute respiratory failure. Two patients presented acute rejection and recovered by adjusting immnosuppression regimen as anti-human T lymphocyte immunoglobulin（ALG） ＋ mycophenolate mofetil （MMF） ＋ tacrolimus （ FK506 ） ＋ methylprednisolone in one, and MMF ＋ FK506 ＋ methylprednisolone after hematodialysis in the other one. Two cases developed lower limb phlebothrombosis and 2 cases developed cerebral thrombosis, who relieved after symptomatic treatment. Conclusions In the treatment of pulmonary infection after renal transplantation, adrenocortical hormone can be used to achieve better efficacy by combining adjustment of immunosuppressant regimen and anti-infective therapy.
出处
《器官移植》
CAS
2012年第6期334-337,共4页
Organ Transplantation
关键词
肾移植
肺部感染
肾上腺皮质激素
免疫抑制剂
巨细胞病毒
Renal transplantation
Pulmonary infection
Adrenocortical hormone
Immunosuppressant
Cytomegalovirus
