CAJ | 학술논문

目的探讨肝移植后泛耐药鲍曼不动杆菌(PDR-Ab)感染者的细胞免疫功能监测及免疫抑制方案的调整.方法回顾性总结2008年1月至2010年5月299例尸体肝移植病例并发PDR-Ab的感染和预后情况.监测肝移植后T淋巴细胞亚群及绝对计数、CD4+T淋巴细胞ATP含量,进行T淋巴细胞免疫功能评分.将14例发生PDR-Ab感染者根据免疫抑制方案的调整不同分为2组,常规治疗组(6例)的他可莫司用量不变,停用吗替麦考酚酯和泼尼松,给予头孢哌酮钠/舒巴坦钠静脉滴注;免疫调节组(8例)在常规治疗的基础上,根据受者的T淋巴细胞免疫功能评分(TCIFS)的动态变化进行免疫抑制方案的调整.结果两组间受者的年龄、终末期肝病模型评分、Child-Pugh评分的差异均无统计学意义(P＞0.05);术中出血量的差异有统计学意义(P＜0.01);术后1周、发生PDR-Ab感染时TCIFS的差异无统计学意义(P＞0.05),但在治疗终点,免疫调节组的TCIFS明显高于常规治疗组(P＜0.05);两组间治愈率的差异有统计学意义(P＜0.05).2个组均未发生排斥反应.结论肝移植后并发PDR-Ab感染时,根据T淋巴细胞亚群计数和CD4+T淋巴细胞ATP值对肝移植受者的细胞免疫功能进行量化评分,以进行免疫抑制方案的调整,是降低肝移植后PDR-Ab感染病死率的有效方法.
목적 탐토간이식후범내약포만불동간균(PDR-Ab)감염자적세포면역공능감측급면역억제방안적조정.방법 회고성총결2008년1월지2010년5월299례시체간이식병례병발PDR-Ab적감염화예후정황.감측간이식후T림파세포아군급절대계수、CD4+T림파세포ATP함량,진행T림파세포면역공능평분.장14례발생PDR-Ab감염자근거면역억제방안적조정불동분위2조,상규치료조(6례)적타가막사용량불변,정용마체맥고분지화발니송,급여두포고동납/서파탄납정맥적주;면역조절조(8례)재상규치료적기출상,근거수자적T림파세포면역공능평분(TCIFS)적동태변화진행면역억제방안적조정.결과 량조간수자적년령、종말기간병모형평분、Child-Pugh평분적차이균무통계학의의(P＞0.05);술중출혈량적차이유통계학의의(P＜0.01);술후1주、발생PDR-Ab감염시TCIFS적차이무통계학의의(P＞0.05),단재치료종점,면역조절조적TCIFS명현고우상규치료조(P＜0.05);량조간치유솔적차이유통계학의의(P＜0.05).2개조균미발생배척반응.결론 간이식후병발PDR-Ab감염시,근거T림파세포아군계수화CD4+T림파세포ATP치대간이식수자적세포면역공능진행양화평분,이진행면역억제방안적조정,시강저간이식후PDR-Ab감염병사솔적유효방법.
Objective To explore the monitoring and the individualized adjustment of cellular immunology function in the recipients infected with pan-drug resistant Acinetobacter baumannii(PDR-Ab)after liver transplantation.Methods We retrospectively summarized the infection and the prognosis of PDR-Ab in 299 cases of liver transplantation performed from Jan.2008 to May 2010.The absolute number of T lymphocytes and ATP level within CD4+ T cells were monitored,and T cell immunology function(TCIFS)was scored.According to different immunology adjusting proposals,14 cases of PDR-Ab infection were divided into 2 groups:(1)traditional group,routine anti-infective therapy;(2)individualized group.Individualized immunology adjustment was made according to the score of TCIFS besides routine therapy.Results There was no significant difference in age,MELD and Child-pugh score between two groups.The peri-operative bleeding volume in individualized group was more than that in traditional group(P<0.01).There was no significant difference in TCIFS score between two groups at 1st week after transplantation and the onset of the PDR-Ab infection.However,the score in individualized group was apparently higher than that in traditional group when anti-infection therapy ended(P<0.05).The difference in the recovery rate between two groups was significant(P<0.05).No rejection happened in two groups.Conclusion It is an effective way to decrease the mortality of PDR-Ab infection after liver transplantation that the individualized adjustment of immunosuppression protocols is guided by grading quantitatively the cellular immunology function according to the absolute number of T lymphocytes and ATP level within CD4+ T cells.