CAJ | 학술논문

目的探讨肝移植后发生严重感染时细胞免疫功能的动态变化和免疫抑制剂的个体化调整.方法回顾分析378例尸体肝移植的临床资料.术后发生严重感染者74例(感染组),其中54例治愈(治愈组),20例死亡(死亡组),以同期50例肝功能正常,未发生感染和排斥反应的肝移植受者为对照组.测定和比较各组受者T淋巴细胞亚群及绝对计数的变化.另根据免疫抑制剂个体化调整策略的不同,将感染组受者分为常规调节组(53例)和个体化调节组(21例),观察免疫抑制方案个体化调整后的疗效.结果与对照组比较,其他3组术前终末期肝病模型(MELD)评分和术中出血量均明显较高(P<0.05);且死亡组均显著高于感染组和治愈组(P<0.05).对照组术后1周到出院时,淋巴细胞和CD4+T淋巴细胞计数均明显升高(P<0.01).与对照组术后1周时比较,感染组术后1周和感染时淋巴细胞和CD4+T淋巴细胞明显较低(P<0.01).治愈组感染控制后CD4+T 淋巴细胞和淋巴细胞计数较术后1周与感染时明显升高(P<0.01).死亡组CD4+T淋巴细胞和淋巴细胞计数持续降低(P<0.05).术后1周和感染时,常规调节组和个体化调节组间各免疫指标的差异无统计学意义(P>0.05),但两组治愈率分别为66.0%(35/53)和90.5%(19/21,P<0.05),急性排斥反应发生率分别为5.7 %(3/53)和0(P>0.05).结论淋巴细胞和CD4+T淋巴细胞计数及其动态变化对肝移植术后感染的发生和预后影响较大.根据免疫功能动态变化对严重感染受者个体化调整免疫抑制剂,有助于改善肝移植严重感染者的预后.
목적 탐토간이식후발생엄중감염시세포면역공능적동태변화화면역억제제적개체화조정.방법 회고분석378례시체간이식적림상자료.술후발생엄중감염자74례(감염조),기중54례치유(치유조),20례사망(사망조),이동기50례간공능정상,미발생감염화배척반응적간이식수자위대조조.측정화비교각조수자T림파세포아군급절대계수적변화.령근거면역억제제개체화조정책략적불동,장감염조수자분위상규조절조(53례)화개체화조절조(21례),관찰면역억제방안개체화조정후적료효.결과 여대조조비교,기타3조술전종말기간병모형(MELD)평분화술중출혈량균명현교고(P<0.05);차사망조균현저고우감염조화치유조(P<0.05).대조조술후1주도출원시,림파세포화CD4+T림파세포계수균명현승고(P<0.01).여대조조술후1주시비교,감염조술후1주화감염시림파세포화CD4+T림파세포명현교저(P<0.01).치유조감염공제후CD4+T 림파세포화림파세포계수교술후1주여감염시명현승고(P<0.01).사망조CD4+T림파세포화림파세포계수지속강저(P<0.05).술후1주화감염시,상규조절조화개체화조절조간각면역지표적차이무통계학의의(P>0.05),단량조치유솔분별위66.0%(35/53)화90.5%(19/21,P<0.05),급성배척반응발생솔분별위5.7 %(3/53)화0(P>0.05).결론 림파세포화CD4+T림파세포계수급기동태변화대간이식술후감염적발생화예후영향교대.근거면역공능동태변화대엄중감염수자개체화조정면역억제제,유조우개선간이식엄중감염자적예후.
Objective To explore the dynamic changes of the cellular immune function in severe infection after liver transplantation, and to guide the individualized immunology adjustment. Methods 378 cases of livertransplantation were analyzed retrospectively. Seventy-four cases (infection group) suffered serious infection, including 54 cases cured (cure group), 20 cases died (death group). Fifty cases without infection and rejection were randomly selected as control group (stable group). According to the individualized adjusting proposal of immunosuppressants, 74 patients with severe infection were divided into two groups: traditional (T) group and individualized (Ⅰ) group. The general condition, recovery rate and change of cellular immune function pre- and post-treatment were analyzed. Results The preoperative MELD score and the intraoperative blood loss in infection group were significantly higher than stable group, and those in death group were higher than in cure group. CD4+ T lymphocyte counts and lymphocyte counts in stable group were increased significantly from first week post-operation to discharge. The two indicators in infection group at first week postoperation and the onset of infection were lower than in stable group (P<0. 01). In cure group after infection was controlled the two indicators were higher than at first week post-operation and the onset of infection (P<0. 01), while in death group they were reduced up to death (P<0. 05). There was no significant difference in age, preoperative MELD score and the immune function indicators both at first week post-operation and the onset of infection between T group and Ⅰ group, except the intraoperative blood loss in Ⅰ group was greater than in T group. The recovery rate in Ⅰ group (90. 5 %)was higher than in T group (66.0 %). Conclusion Individualized adjustments of immunosuppressants guided according to the dynamic changes of cellular immune function helped to improve the prognosis of severe infection after liver transplantation.