免疫球蛋白防治肾移植后T淋巴细胞降低肺部感染

摘要

背景:肾移植后T 淋巴细胞降低就容易发生感染,肺部是主要靶器官,因此如何控制肺部感染,尤其是重症肺炎,成为改善肾移植患者预后关键所在.目的:探讨在肾移植后未发生肺部感染之前,根据监测到T 淋巴细胞水平降低,予用免疫球蛋白预防肺部感染的作用.方法:纳入肾移植后半年内患者30 例,随机分成治疗组和对照组各15 例,所有患者均采用原有的免疫抑制剂.治疗组加用免疫球蛋白0.2 g/(kg·d),2 次/d,临床观察肺部感染发生率,移植肾功能和T 淋巴细胞水平.结果与结论:免疫球蛋白治疗组普通肺炎和重症肺炎发生及死亡率明显低于对照组(P ＜ 0.05),CD4+T 淋巴细胞水平和CD4+/CD8+T 淋巴细胞比值明显上升(P ＜ 0.01),动态观察两组7,14,21 d CD4+T 淋巴细胞的亚群数目明显高于对照组(P ＜ 0.01),而肾功能无变化.结果提示,免疫球蛋白能提高肾移植后患者T 淋巴细胞水平,恢复机体免疫功能,增强抗感染能力,从而减少肺部感染的发生.%BACKGROUND: Decrease in T lymphocyte after renal transplantation can easily lead to pneumonia. As a key target organ, it is important to control pneumonia, especially severe pneumonia, which becomes a key for patient's prognosis following renal transplantation .OBJECTIVE: To investigate the effect of immunoglobulin against pneumonia after renal transplantation based on decreased T lymphocytes.METHODS: Thirty patients accepting renal transplantation within six month were enrolled, and randomly divided into treatment group (15 cases) and control group (15 cases). All the patients were received immunosuppressive agents. The patients in the treatment group were treated with immunoglobulin 0.2 g/(kg·d), twice per day, and other therapy options were similar to the control group. The incidence of pulmonary infection, renal function and T lymphocyte level were detected.RESULTS AND CONCLUSION: The incidence of ordinary pneumonia and severe pneumonia and the mortality in the treatment group were significantly lower than those in the control group (P ＜ 0.05). CD4+ T lymphocyte and CD4+/CD8+ T lymphocytes subsets were significantly increased (P ＜ 0.01), and CD4+ T lymphocyte subsets was significantly higher in 7, 14, 21 day as compared to the baseline (P ＜ 0.01), but there was no change in renal function. Our findings suggested that patients treated with immunoglobulin after renal transplantation can improve the level of T lymphocytes, immune function and reduce the incidence of pulmonary infection.