中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2009年
6期
334-337
,共4页
熊海云%张雷%王立明%康印东%曾力%周梅生%周琳%张玲珍%韩澍%傅尚希%袁清%赵闻雨%陈瑜%朱有华
熊海雲%張雷%王立明%康印東%曾力%週梅生%週琳%張玲珍%韓澍%傅尚希%袁清%趙聞雨%陳瑜%硃有華
웅해운%장뢰%왕립명%강인동%증력%주매생%주림%장령진%한주%부상희%원청%조문우%진유%주유화
肾移植%CD4淋巴细胞计数%肺%感染
腎移植%CD4淋巴細胞計數%肺%感染
신이식%CD4림파세포계수%폐%감염
Kidney transplantation%CD4+ lvmphocyte count%Lung%Infection
目的 探讨肾移植术后早期严重肺部感染患者外周血CD4+T淋巴细胞计数的临床意义.方法 采用流式细胞术检测2007年2月至2008年6月期间,肾移植术后早期发生严重肺部感染的28例患者(感染组)外周血CD4+T淋巴细胞计数的变化,并随机选取同期肾移植术后病情稳定的30例患者(对照组)作为对照.结果 肾移植术后早期,感染组患者入院第1天CD4+T淋巴细胞计数显著低于对照组,分别为(184.1±117.5)个/μl和(518.6±232.7)个/μl(P<0.01).感染组患者中有5例治疗无效死亡,其中4例CD4+T淋巴细胞计数呈持续降低趋势;感染组中存活的患者在治疗恢复后,CD4+T淋巴细胞计数明显上升至(406.5±163.9)个/μl,与治疗前比较,P<0.01.受试者工作特征(ROC)曲线分析表明,CD4+T淋巴细胞计数减少能作为判断发生肺部感染的有效指标,其曲线下面积(AUC)为94.9%(P<0.01),CD4+T淋巴细胞计数为220个/μL时,其特异度为100%.结论 外周血CD4+T淋巴细胞的变化与肾移植术后早期严重肺部感染的转归密切相关.CD4+T淋巴细胞计数低于220个/μl的患者发生感染的可能性极大;测定外周血CD4+T淋巴细胞计数并动态分析对于优化治疗和判断预后有重要的参考价值.
目的 探討腎移植術後早期嚴重肺部感染患者外週血CD4+T淋巴細胞計數的臨床意義.方法 採用流式細胞術檢測2007年2月至2008年6月期間,腎移植術後早期髮生嚴重肺部感染的28例患者(感染組)外週血CD4+T淋巴細胞計數的變化,併隨機選取同期腎移植術後病情穩定的30例患者(對照組)作為對照.結果 腎移植術後早期,感染組患者入院第1天CD4+T淋巴細胞計數顯著低于對照組,分彆為(184.1±117.5)箇/μl和(518.6±232.7)箇/μl(P<0.01).感染組患者中有5例治療無效死亡,其中4例CD4+T淋巴細胞計數呈持續降低趨勢;感染組中存活的患者在治療恢複後,CD4+T淋巴細胞計數明顯上升至(406.5±163.9)箇/μl,與治療前比較,P<0.01.受試者工作特徵(ROC)麯線分析錶明,CD4+T淋巴細胞計數減少能作為判斷髮生肺部感染的有效指標,其麯線下麵積(AUC)為94.9%(P<0.01),CD4+T淋巴細胞計數為220箇/μL時,其特異度為100%.結論 外週血CD4+T淋巴細胞的變化與腎移植術後早期嚴重肺部感染的轉歸密切相關.CD4+T淋巴細胞計數低于220箇/μl的患者髮生感染的可能性極大;測定外週血CD4+T淋巴細胞計數併動態分析對于優化治療和判斷預後有重要的參攷價值.
목적 탐토신이식술후조기엄중폐부감염환자외주혈CD4+T림파세포계수적림상의의.방법 채용류식세포술검측2007년2월지2008년6월기간,신이식술후조기발생엄중폐부감염적28례환자(감염조)외주혈CD4+T림파세포계수적변화,병수궤선취동기신이식술후병정은정적30례환자(대조조)작위대조.결과 신이식술후조기,감염조환자입원제1천CD4+T림파세포계수현저저우대조조,분별위(184.1±117.5)개/μl화(518.6±232.7)개/μl(P<0.01).감염조환자중유5례치료무효사망,기중4례CD4+T림파세포계수정지속강저추세;감염조중존활적환자재치료회복후,CD4+T림파세포계수명현상승지(406.5±163.9)개/μl,여치료전비교,P<0.01.수시자공작특정(ROC)곡선분석표명,CD4+T림파세포계수감소능작위판단발생폐부감염적유효지표,기곡선하면적(AUC)위94.9%(P<0.01),CD4+T림파세포계수위220개/μL시,기특이도위100%.결론 외주혈CD4+T림파세포적변화여신이식술후조기엄중폐부감염적전귀밀절상관.CD4+T림파세포계수저우220개/μl적환자발생감염적가능성겁대;측정외주혈CD4+T림파세포계수병동태분석대우우화치료화판단예후유중요적삼고개치.
Objective To explore the clinical implication of peripheral blood CD4+ T-cell counts in renal allograft recipients with severe pulmonary infection in the early stage after kidney transplantation. Methods From February 2007 to June 2008, we investigated the variation of peripheral blood CD4+ T-cell counts using flow cytometry in 28 cases of severe pulmonary infection 1 ～6 months after kidney transplantation (infection group), and 30 cases (control group) randomly selected that had stable situation and normal kidney function in the same period. Results CD4+ T-cell counts on the day of admission in infection group were significantly lower than in control group (184.1 ±117.5/μl vs. 518.6±232.7/μl, P<0.01 ). In infection group, 5 patients died and 4 of them had obviously declining trends of CD4+ T-cell counts during hospitalization course. Comparing to the day of admission, CD4+ T-cell counts of those survivors in infection group were significantly increased (184.1±117.5/μl vs. 406.5±163.9/μl, P<0.01) when infections were controlled. ROC analysis showed that CD4+ T-cell counts on the day of admission were accurate enough to identify who were susceptible to infection. In detail, the area under the curve (AUC) was 94.9% (P<0.01). CD4+ T-cell counts of 220/μl displayed the minimal misdiagnosis rate. Conclusions The variations of CD4+ T-cell counts are correlated to onset and progression of severe pulmonary infection in the early stage after kidney transplantation. Those who had CD4+ T-cell counts lower than 220/μl were at high risk of pulmonary infection. Direct measure and dynamic analysis of CD4+ T-cell subset have an important role in optimizing treatment and predicting prognosis of severe pulmonary infection in the early stage after kidney transplantation.
