实用器官移植电子杂志
實用器官移植電子雜誌
실용기관이식전자잡지
Practical Journal of Organ Transplantation (Electronic Version)
2013年
2期
95-102
,共8页
董彪%王钢%王伟刚%王远涛%周洪澜%傅耀文
董彪%王鋼%王偉剛%王遠濤%週洪瀾%傅耀文
동표%왕강%왕위강%왕원도%주홍란%부요문
肾移植手术%间质性肺炎%免疫抑制方案%糖皮质激素%抗体诱导治疗
腎移植手術%間質性肺炎%免疫抑製方案%糖皮質激素%抗體誘導治療
신이식수술%간질성폐염%면역억제방안%당피질격소%항체유도치료
Renal transplantation%Interstitial pneumonia%Immunosuppressant%Glucocorticosteroids%Antibody induction
目的探讨肾移植术后间质性肺炎的早期诊断、预防及处理原则。方法选择吉林大学第一医院泌尿系统疾病诊治中心2008年至2011年肾移植术后出现间质性肺炎患者83例。比较2008年1-12月与2009年1月-2011年12月两个时期肾移植患者术后预防及治疗的差异，以及间质性肺炎的发生情况。结果2008年1-12月138例患者进行肾移植，术后发生间质性肺炎38例，发生率为27.54%；2009-2011年435例患者行肾移植，45例术后发生间质性肺炎，发生率为10.34%。2008年组肾移植术后患者早期住院期间给予静脉注射更昔洛韦针剂，出院后口服更昔洛韦片剂及复方新诺明片剂。2009-2011年组肾移植术后患者出院后根据患者血药浓度及血肌酐水平给予口服更昔洛韦片剂及复方新诺明片剂。在患者检查肺部CT确诊为间质性肺炎后入院，2008年组采取根据患者的病情减少或停用免疫抑制剂，给予适量糖皮质激素冲击、更昔洛韦抗病毒及联合复方新诺明抗原虫治疗；2009-2011年组则采取根据患者的病情情况使用规律性大剂量糖皮质激素冲击，并停用免疫抑制剂，同时抗病毒及联合复方新诺明抗原虫治疗。2008年组治愈/好转35例，死亡2例，1例放弃治疗，治疗期间发生排异反应3例。2009-2011年组治愈/好转45例，死亡0例，治疗期间发生排异反应3例。2008-2011年573例肾移植术患者中，接受巴利昔单抗或抗胸腺细胞球蛋白（ATG）等抗体诱导治疗183例，未接受抗体诱导治疗390例；在83例肾移植术后发生间质性肺炎患者中，有27例患者应用巴利昔单抗或ATG等抗体诱导治疗，其余56例未接受抗体诱导治疗。结论①早期停用免疫抑制剂、给予糖皮质激素冲击治疗、更昔洛韦抗巨细胞病毒治疗、联合应用复方新诺明抗原虫治疗及有效的营养支持是治疗肾移植术后治疗间质性肺炎的有力措施。②在有效的肾移植术后预防间质性肺炎用药指导下，肾移植患者术前接受抗体诱导治疗未见其增加术后发生间质性肺炎的概率。
目的探討腎移植術後間質性肺炎的早期診斷、預防及處理原則。方法選擇吉林大學第一醫院泌尿繫統疾病診治中心2008年至2011年腎移植術後齣現間質性肺炎患者83例。比較2008年1-12月與2009年1月-2011年12月兩箇時期腎移植患者術後預防及治療的差異，以及間質性肺炎的髮生情況。結果2008年1-12月138例患者進行腎移植，術後髮生間質性肺炎38例，髮生率為27.54%；2009-2011年435例患者行腎移植，45例術後髮生間質性肺炎，髮生率為10.34%。2008年組腎移植術後患者早期住院期間給予靜脈註射更昔洛韋針劑，齣院後口服更昔洛韋片劑及複方新諾明片劑。2009-2011年組腎移植術後患者齣院後根據患者血藥濃度及血肌酐水平給予口服更昔洛韋片劑及複方新諾明片劑。在患者檢查肺部CT確診為間質性肺炎後入院，2008年組採取根據患者的病情減少或停用免疫抑製劑，給予適量糖皮質激素遲擊、更昔洛韋抗病毒及聯閤複方新諾明抗原蟲治療；2009-2011年組則採取根據患者的病情情況使用規律性大劑量糖皮質激素遲擊，併停用免疫抑製劑，同時抗病毒及聯閤複方新諾明抗原蟲治療。2008年組治愈/好轉35例，死亡2例，1例放棄治療，治療期間髮生排異反應3例。2009-2011年組治愈/好轉45例，死亡0例，治療期間髮生排異反應3例。2008-2011年573例腎移植術患者中，接受巴利昔單抗或抗胸腺細胞毬蛋白（ATG）等抗體誘導治療183例，未接受抗體誘導治療390例；在83例腎移植術後髮生間質性肺炎患者中，有27例患者應用巴利昔單抗或ATG等抗體誘導治療，其餘56例未接受抗體誘導治療。結論①早期停用免疫抑製劑、給予糖皮質激素遲擊治療、更昔洛韋抗巨細胞病毒治療、聯閤應用複方新諾明抗原蟲治療及有效的營養支持是治療腎移植術後治療間質性肺炎的有力措施。②在有效的腎移植術後預防間質性肺炎用藥指導下，腎移植患者術前接受抗體誘導治療未見其增加術後髮生間質性肺炎的概率。
목적탐토신이식술후간질성폐염적조기진단、예방급처리원칙。방법선택길림대학제일의원비뇨계통질병진치중심2008년지2011년신이식술후출현간질성폐염환자83례。비교2008년1-12월여2009년1월-2011년12월량개시기신이식환자술후예방급치료적차이，이급간질성폐염적발생정황。결과2008년1-12월138례환자진행신이식，술후발생간질성폐염38례，발생솔위27.54%；2009-2011년435례환자행신이식，45례술후발생간질성폐염，발생솔위10.34%。2008년조신이식술후환자조기주원기간급여정맥주사경석락위침제，출원후구복경석락위편제급복방신낙명편제。2009-2011년조신이식술후환자출원후근거환자혈약농도급혈기항수평급여구복경석락위편제급복방신낙명편제。재환자검사폐부CT학진위간질성폐염후입원，2008년조채취근거환자적병정감소혹정용면역억제제，급여괄량당피질격소충격、경석락위항병독급연합복방신낙명항원충치료；2009-2011년조칙채취근거환자적병정정황사용규률성대제량당피질격소충격，병정용면역억제제，동시항병독급연합복방신낙명항원충치료。2008년조치유/호전35례，사망2례，1례방기치료，치료기간발생배이반응3례。2009-2011년조치유/호전45례，사망0례，치료기간발생배이반응3례。2008-2011년573례신이식술환자중，접수파리석단항혹항흉선세포구단백（ATG）등항체유도치료183례，미접수항체유도치료390례；재83례신이식술후발생간질성폐염환자중，유27례환자응용파리석단항혹ATG등항체유도치료，기여56례미접수항체유도치료。결론①조기정용면역억제제、급여당피질격소충격치료、경석락위항거세포병독치료、연합응용복방신낙명항원충치료급유효적영양지지시치료신이식술후치료간질성폐염적유력조시。②재유효적신이식술후예방간질성폐염용약지도하，신이식환자술전접수항체유도치료미견기증가술후발생간질성폐염적개솔。
Objective To investigate the early diagnosis,prophylaxis and treatment principles of interstitial pneumonia in renal transplant recipients. Methods 83 kidney transplant recipients who diagnosed with interstitial pneumonia during the period from 2008 to 2011 in the Urinary Diseases Diagnosis&Treatment Center, First Hospital of Jilin University were enrolled in this study. The difference of prophylaxis,treatment with interstitial pneumonia and the occurrence of interstitial pneumonia after renal transplantation between January - December, 2008 and January 2009-December 2011 were compared. Results There were a total of 138 patients underwent allograft renal transplantation during the period from January 2008 to December 2008,and 38 of the kidney recipients developed interstitial pneumonia and the incidence rate was 27.54%. There were a total of 435 patients underwent allograft renal transplantation during the period from January 2009 to December 2011,and 45 of the kidney recipients developed interstitial pneumonia and the incidence rate was 10.34%. Kidney transplant recipients during the period from January 2008 to December 2008 received intravenous ganciclovir during the hospital stay and oral ganciclovir in the post-discharge period. Kidney transplant recipients during the period from January 2009 to December 2011 received oral ganciclovir and trimethoprim-sulfamethoxazole(SMZ-TMP)in the post-discharge period according to the plasma concentration and the level of serum creatinine. When diagnosed with interstitial pneumonia by pulmonary CT,the immunosuppressive drugs of the recipients during the period from January 2008 to December 2008 were reduced or withdrew,and corticosteroid therapy,ganciclovir resistant cytomegalovirus(CMV)treatment, combination with the cotrimoxazole antiprotozoal treatment were given. The recipients during the period from January 2009 to December 2011 were received regular high-dose corticosteroid and withdrew the immunosuppressive drugs, given ganciclovir resistant CMV treatment with combination of cotrimoxazole antiprotozoal treatment. In the group of recipients during the period from January 2008 to December 2008,35 cases were cured/improved,2 cases died, 1 case abandoned treatment and 3 cases developed rejection reaction during the treatment period. In the group of recipients during the period from January 2009 to December 2011,45 cases were cured/improved,no case died and 3 cases developed rejection reaction during the treatment period. There were a total of 573 patients underwent allograft renal transplantation during the period from 2008 to 2011,among who 183 patients received antibody induction therapy including basiliximab or antithymocyte globulin(ATG),and the other 390 patients did not receive. Among 83 patients who developed interstitial pneumonia after kidney transplantation,27 patients received antibody induction therapy including basiliximab or ATG,while 56 patients did not receive. Conclusions Early discontinuation of immunosuppressive agents and given corticosteroid therapy,ganciclovir resistant CMV treatment,combination the cotrimoxazole antiprotozoal treatment and effective nutrition support therapy were effective in the treatment of interstitial pneumonia after renal transplantation. In addition,under effective medication guide for interstitial pneumonia prevention after renal transplantation,kidney transplant patients' occurrence of interstitial pneumonia was not significantly associated with their use of antibody induction therapy.
