CAJ | 학술논문

目的探讨肾移植后采用巴利昔单抗诱导治疗时的感染发生情况以及采取感染预防措施的效果.方法回顾分析2001年1月至2010年12月间肾移植后接受巴利昔单抗诱导治疗者的资料,共有204例患者人选,其中118例采取感染预防措施(预防组),余下86例未行感染预防(对照组).同期440例未接受巴利昔单抗以及其他抗体类制剂的肾移植受者,其中234例未采取感染预防措施(无诱导对照组),206例采取了感染预防措施(无诱导预防组).诱导治疗方案为移植术前2 h和术后第4天各滴注巴利昔单抗20mg,感染预防方案为更昔洛韦+联磺甲氧苄啶.分析感染并发症与抗体治疗的关系以及预防感染的效果.结果 204例应用巴利昔单抗诱导治疗者中,预防组23例(19.5%,23/118)因感染需住院治疗,其中重症病例3例(13.0%,3/23),因感染死亡3例(13.0%,3/23);对照组为27例(31.4%,27/86)因感染需住院治疗,其中重症病例7例(25.9%,7/27),因感染死亡4例(14.8%,4/27);预防组和对照组感染发生率的差异有统计学意义(P＜0.05),两组间重症感染率的差异有统计学意义(P＜0.05),而死亡率的差异无统计学意义(P＞0.05).同期肾移植后未行抗体诱导治疗440例,无诱导预防组感染发生率为15.0%(31/206),无重症病例,因感染死亡7例(22.6%,7/31);无诱导对照组感染发生率为12.8%(30/234),其中重症病例3例(10.0%,3/30),因感染死亡5例(16.7%,5/30).在未采取感染预防措施的情况下,采用抗体诱导治疗者的感染发生率(31.4%)明显高于无诱导者(12.8%),差异有统计学意义(P＜0.01).结论肾移植后应用巴利昔单抗诱导治疗存在感染风险,但不增加死亡率;联合采取感染预防措施可以降低感染发生率和重症感染率,能有效预防感染并发症.
목적 탐토신이식후채용파리석단항유도치료시적감염발생정황이급채취감염예방조시적효과.방법 회고분석2001년1월지2010년12월간신이식후접수파리석단항유도치료자적자료,공유204례환자인선,기중118례채취감염예방조시(예방조),여하86례미행감염예방(대조조).동기440례미접수파리석단항이급기타항체류제제적신이식수자,기중234례미채취감염예방조시(무유도대조조),206례채취료감염예방조시(무유도예방조).유도치료방안위이식술전2 h화술후제4천각적주파리석단항20mg,감염예방방안위경석락위+련광갑양변정.분석감염병발증여항체치료적관계이급예방감염적효과.결과 204례응용파리석단항유도치료자중,예방조23례(19.5%,23/118)인감염수주원치료,기중중증병례3례(13.0%,3/23),인감염사망3례(13.0%,3/23);대조조위27례(31.4%,27/86)인감염수주원치료,기중중증병례7례(25.9%,7/27),인감염사망4례(14.8%,4/27);예방조화대조조감염발생솔적차이유통계학의의(P＜0.05),량조간중증감염솔적차이유통계학의의(P＜0.05),이사망솔적차이무통계학의의(P＞0.05).동기신이식후미행항체유도치료440례,무유도예방조감염발생솔위15.0%(31/206),무중증병례,인감염사망7례(22.6%,7/31);무유도대조조감염발생솔위12.8%(30/234),기중중증병례3례(10.0%,3/30),인감염사망5례(16.7%,5/30).재미채취감염예방조시적정황하,채용항체유도치료자적감염발생솔(31.4%)명현고우무유도자(12.8%),차이유통계학의의(P＜0.01).결론 신이식후응용파리석단항유도치료존재감염풍험,단불증가사망솔;연합채취감염예방조시가이강저감염발생솔화중증감염솔,능유효예방감염병발증.
Objective To investigate the incidence of infection and the effect of anti-infection prophylaxis in renal transplanted patients after Basiliximab induction therapy. Methods A total of 204patients who have received renal transplantation and Basiliximab induction therapy from January 1,2001 to December 31, 2010 in our hospital have been retrospective analysed in this study. These patients were divided into a prophylaxis group (118 cases) with Ganciclovir + Sulfadiazine +Trimethoprim therapy and a control group (86 cases) without any anti-infection prophylaxis.Furthermore, 440 transplanted patients in the same peroid without any induction therapy were also analysed. They were also devided into two groups: an anti-infection prophylaxis group (206 cases)and a control group (234 cases) without any anti-infection prophylaxis. Results In the prophylaxis group with Basiliximab induction therapy, there were 23 patients (19. 5 %, 23/118)experienced hospitalization due to infection, 3 cases (13. 0 %,3/23) among them were severe infection, and 3patients (13.0 %, 3/23) died from vital infection. In the non-prophylaxis control group with Basiliximab induction therapy, 27 patients (31.4 %, 27/86) had infection complication, 7 patients (25.9 % ,7/27) among them were severe infection, and 4 patients(14. 8 % ,4/27)died. The incidence of infection between the above two groups is significantly different (P＜0. 05). In the prophylaxis group without induction therapy, the incidence of infection was 15.0 % (31/206), there were no severe infection cases but 7 patients (22. 6 %, 7/31) died from infection. In the non-prophylaxis control group without induction therapy, the incidence of infection was 12. 8 % (30/234), 3 cases among them were severe infection(10. 0 %,3/30)and 5 patients died from infection (16. 7 %, 5/30).The incidence of infection in Basiliximab induced patients without anti-infection prophylaxis is significantly higher than that in patients without induction therapy and anti-infection prophylaxis (31.4 % vs. 12.8 %,P＜0.01). Conclusion Basiliximab induction therapy increased the risk of infection, but not the rate of mortality. It is necessary to give anti-infection prophylaxis in renal transplanted patients with Basiliximab induction therapy.