CAJ | 학술논문

背景：肾移植后肺部感染病情进展快，重症肺炎死亡率高，对其进行早期诊断及治疗具有重要意义，但部分患者因免疫抑制剂的调整，出现移植肾功能受损。目的：探讨肾移植后肺部感染治疗过程中免疫抑制剂的应用方案。方法：回顾分析85例肺部感染的肾移植患者的临床资料。肺部感染发生于肾移植后1-6个月43例(其中2-4个月39例)，6-12个月7例，12-24个月7例，24-36个月6例，大于36个月22例。根据患者病情，予以调整免疫抑制剂，联合应用小剂量激素抗炎保护移植肾功能，针对病原学抗感染，呼吸衰竭者给予呼吸机辅助呼吸，同时予以降温及营养支持等对症治疗。肺部感染早期减少或停用免疫抑制44例，进展期减少或调整免疫制剂19例，重症肺炎期停用免疫抑制剂5例，肺炎早期及进展期逐步调整免疫抑制15例，肺炎早期减量至重症肺炎停用免疫抑制剂2例。减少或停用免疫抑制剂3-51 d，平均10.7 d。结果与结论：85例患者中治愈81例，死亡4例。4例死亡病例中，2例死于急性呼吸衰竭，2例死于多器官功能衰竭。治愈的81例中出现急性排异反应3例，移植肾功能受损6例。结果提示，肾移植后肺部感染短时间减少或停用免疫抑制剂，有利于提高治愈率，减少死亡率，及时恢复免疫制剂的应用，能有效保护移植肾功能，尤其是移植肾功能不全患者，肺部炎症进展控制住，及时恢复免疫抑制，在保护移植肾功能的意义更大。
배경：신이식후폐부감염병정진전쾌，중증폐염사망솔고，대기진행조기진단급치료구유중요의의，단부분환자인면역억제제적조정，출현이식신공능수손。목적：탐토신이식후폐부감염치료과정중면역억제제적응용방안。방법：회고분석85례폐부감염적신이식환자적림상자료。폐부감염발생우신이식후1-6개월43례(기중2-4개월39례)，6-12개월7례，12-24개월7례，24-36개월6례，대우36개월22례。근거환자병정，여이조정면역억제제，연합응용소제량격소항염보호이식신공능，침대병원학항감염，호흡쇠갈자급여호흡궤보조호흡，동시여이강온급영양지지등대증치료。폐부감염조기감소혹정용면역억제44례，진전기감소혹조정면역제제19례，중증폐염기정용면역억제제5례，폐염조기급진전기축보조정면역억제15례，폐염조기감량지중증폐염정용면역억제제2례。감소혹정용면역억제제3-51 d，평균10.7 d。결과여결론：85례환자중치유81례，사망4례。4례사망병례중，2례사우급성호흡쇠갈，2례사우다기관공능쇠갈。치유적81례중출현급성배이반응3례，이식신공능수손6례。결과제시，신이식후폐부감염단시간감소혹정용면역억제제，유리우제고치유솔，감소사망솔，급시회복면역제제적응용，능유효보호이식신공능，우기시이식신공능불전환자，폐부염증진전공제주，급시회복면역억제，재보호이식신공능적의의경대。
BACKGROUND:Pulmonary infection after kidney transplantation evolves rapidly. There is a high mortality rate in patients with server pulmonary infection. It has the important significance of early diagnosis and treatment of pulmonary infection, but some patients appear to have impaired kidney function because of the adjustment of immunosuppressants. OBJECTIVE:To explore the approaches to applying the immunosuppressants during the treatment of pulmonary infection after kidney transplantation. METHODS:The clinical data of 85 kidney transplantation patients who suffered from pulmonary infection were retrospectively analyzed. There were 43 cases in which the infection occurred within 1-6 months after kidney transplantation, 39 of which within 2-4 months; 7 cases of infection occurring within 6-12 months; 7 cases of infection within 12-24 months; 6 cases of infection within 24-36 months; 22 cases of infection occurring beyond 36 months. The immunosuppressant dose was adjusted based on a per-case basis. As a complement, the smal-dose hormone was used for anti-inflammation. Etiological treatments for resisting infections were also conducted accordingly. Ventilators were utilized for patients with respiratory failures. The body temperature of patients was monitored and controled. Appropriate nutrition support was also provided accordingly. There were 44 cases of decreasing or stopping the use of immunosuppressants during the early period of pulmonary infection; 19 cases of decreasing or stopping the use of immunosuppressants during the treatment of pulmonary infection;5 cases of stopping the use of immunosuppressants during the period of severe pneumonia; 15 cases of gradualy changing the dose of immunosuppressants during the early and progressive period of pneumonia; 2 cases of decreasing the use during the early period of pneumonia and stopping the use during the period of severe pneumonia. The duration of decreasing or stopping the use of immunosuppressants ranged from 3-51 days, with an average of 10.7 days. RESULTS AND CONCLUSION: Among the 85 patients, there were 81 cases cured and 4 cases of death. Among the four death cases, two cases died of acute respiratory failure and two cases died of multiple organ failure. Of the cured 81 cases, acute rejection occurred in 3 cases, while renal alograft dysfunction occurred in 6 cases. Decreasing or temporarily stopping the use of immunosuppressants during the treatment of pulmonary infection caused by the kidney transplantation increases the cure rate and decreases the mortality rate; while timely resuming the usage of immunosuppressants effectively protects the renal graft function, especialy for patients with renal graft dysfunction.