CAJ | 학술논문

目的探讨肝移植感染调整免疫抑制剂的方法 .方法 2005年1月-2007年12月采用感染相关器官衰竭评分(SOFA)在肝移植后发生感染者SOFA≥15分时,停用免疫抑制剂,并予综合治疗;再根据SOFA评分将其进一步分为SOFA 15～17分(A组,10例)和≥18分(B组,16例)两组,并以2003年3月-2004年12月肝移植后发生感染未停用免疫抑制剂者为对照(C组,13例),观察调整免疫抑制剂对排斥反应和预后的影响,及其发生时间和SOFA评分的关系.结果调整免疫抑制剂后,随着感染的控制,有9例发生排斥反应,A组5例(50.0%),B组4例(25.0%),C组无一例发生;3组问比较差异有统计学意义(X2=8.0,P=0.02),但A,B组间差异无统计学意义(X2=1.70,P=0.19).发生排斥反应时,SOFA评分较停用抗排斥反应药物时明显降低[(9.78±3.14)分比(17.22±1.86)分,t=6.10,P=0.003.发生排斥反应的时间平均为停用免疫抑制剂后(17.56±2.60)d.共死亡25例患者,其中A组5例(50.0%),B组7例(43.8%),C组13例(100.0%);发生排斥反应的患者无一例死于严重感染所致多器官衰竭;调整免疫抑制剂可降低肝移植感染的病死率(X2=7.60,P=0.02).结论 SOFA可用于指导肝移植感染免疫抑制剂的调整,当SOFA≥15分时停用免疫抑制剂,可以不增加排斥反应的发生率,且能减少病死率;SOFA评分越低,病情好转越快,但越容易发生排斥反应.为及时调整免疫抑制剂的使用,可缩短SOFA评分间隔.
목적 탐토간이식감염조정면역억제제적방법 .방법 2005년1월-2007년12월채용감염상관기관쇠갈평분(SOFA)재간이식후발생감염자SOFA≥15분시,정용면역억제제,병여종합치료;재근거SOFA평분장기진일보분위SOFA 15～17분(A조,10례)화≥18분(B조,16례)량조,병이2003년3월-2004년12월간이식후발생감염미정용면역억제제자위대조(C조,13례),관찰조정면역억제제대배척반응화예후적영향,급기발생시간화SOFA평분적관계.결과 조정면역억제제후,수착감염적공제,유9례발생배척반응,A조5례(50.0%),B조4례(25.0%),C조무일례발생;3조문비교차이유통계학의의(X2=8.0,P=0.02),단A,B조간차이무통계학의의(X2=1.70,P=0.19).발생배척반응시,SOFA평분교정용항배척반응약물시명현강저[(9.78±3.14)분비(17.22±1.86)분,t=6.10,P=0.003.발생배척반응적시간평균위정용면역억제제후(17.56±2.60)d.공사망25례환자,기중A조5례(50.0%),B조7례(43.8%),C조13례(100.0%);발생배척반응적환자무일례사우엄중감염소치다기관쇠갈;조정면역억제제가강저간이식감염적병사솔(X2=7.60,P=0.02).결론 SOFA가용우지도간이식감염면역억제제적조정,당SOFA≥15분시정용면역억제제,가이불증가배척반응적발생솔,차능감소병사솔;SOFA평분월저,병정호전월쾌,단월용역발생배척반응.위급시조정면역억제제적사용,가축단SOFA평분간격.
Objective To explore the method of adjusting the immunosuppressants in serious infection after liver transplantation.Metho.With reference to sepsis-related organ failure assessment(SOFA),2005.1-2007.12,when the patient's score≥15,the immunosuppressants were withdrawn,and the patients were given powerful antibiotics and the other treatments in combination.They were further divided into two groups,SOFA 15-17(group A,10 cases)and≥18(group B,16 cases).They were compared,and also with the patients without stoppage of immunosuppressants(group C,13 cases,2003.3-2004.1 2).After withdrawing the immunosuppressant,the rejection incidence and times,the changes in SOFA score and mortality and their relationships were analyzed.Results After adjusting the immunosuppressant and with control of serious infections,rejection occurred in 9 patients,with 5 cases in group A(50.0%),4 in B (25.0%),none in C.The differences among groups showed statistically significant difference(X2=8.0,P=0.02),but no difference was seen between group A and B(X2=1.70,P=0.19).When the rejection developed,the SOFA score decreased obviously(9.78±3.14 vs.17.22±1.86,t=6.10,P=0.00).The time of rejection was(17.56±2.60)days after stopping the immunosuppressant.Al 25 deaths were due to serious infection with multiple organ dysfunction syndrome,but not rejection.Five deaths occurred in group A(50.0%),7 in B(43.8%),13 in C(100.0%).Not a single patient with rejection died from infection.Proper adjustment of the immunosuppressants could decrease the mortality(X2=7.60,P=0.02).Conclusion SOFA score could be used to guide the adjustment of the immunosuppressants,when SOFA≥15,the immunosuppressants could be stopped,which would not increase the rejection incidence and decrease mortality.The lower the SOFA score is,the faster the patients recuperate better,but more rejection develops.In order to adjust the immunosuppressant in time,the period with high SOFA score should be shortened.