大蒜油胶囊预防肾移植后真菌感染的临床研究

目的 探讨大蒜油胶囊预防肾移植后真菌感染的效果。方法 62例肾移植患者术后口服大东油胶囊预防真菌感染,与58例未用者（对照组）进行比较,结果 预防用药的62例仅1例发生真菌感染,而对照组58例中6例发生真菌感染。结论 肾移植后应用大蒜油胶囊可减少真菌感染的发生。     

肾移植术后预防肺部感染的护理

在肾移植患者的死亡原因中，感染居首位。肺部感染是肾移植术后各种感染中发病率最高的并发症，而且具有病情重、发展快、临床治疗困难的特点。因此，应高度重视其预防。如何有效预防肾移植术后肺部感染就成为了护理的重点之一。     

肾移植术后感染的预防和治疗

肾移植是治疗终末期肾病的最好办法,但患者术前病程长,抵抗力较差,加上术后大量应用免疫抑制剂,术后感染较常见。我院1985年4月～2007年7月行肾移植手术336例,现就术后感染的预防和治疗体会总结如下。     

肝炎病毒携带者肾移植后的处理

目的探讨肝炎病毒携带者。肾移植后的处理。方法14例患者中，8例感染乙型肝炎病毒（HBV），4例感染丙型肝炎病毒（HCV），2例同时感染HBV和HCV，移植术前肝炎病毒DNA或RNA阴性。结果术后随访3～20个月，10例患者于术后2周内出现程度不等的肝功能异常，均以丙氨酸转氨酶和天冬氨酸转氨酶升高为主，HBVDNA和／或HCVRNA均呈阴性，经调整免疫抑制剂用量，并给予护肝治疗，患者的肝功能均恢复正常。结论肝炎病毒携带者接受肾移植后，出现肝功能异常时，应正确区分系药物性肝损害还是病毒性肝损害，及时采取相应处理，并给予护肝治疗。     

肾移植术后肺部真菌感染的临床特征

目的：探讨肾移植术后肺部真菌感染的临床特征。方法：报告27例肾移植术后肺部真菌感染患者的临床资料。27例均有发热、咳嗽，17例出现胸闷、低氧血症。病原学检查发现白色念珠菌6例，克柔念珠菌5例，平滑念珠菌4例，12例阴性，混合细菌感染15例，巨细胞病毒感染4例。结果：单纯应用酮康唑治愈者10例，应用两性霉素B脂质体治愈10例，7例死亡。结论：真菌是肾移植术后肺部感染主要原因之一，早期发现、及时治疗、合理应用免疫治疗方案是治疗成功的关键。     

肾移植术后机会感染的预防

目的探讨预防肾移植术后机会感染的有效方法。方法同种异体肾移植患者30例,术后常规予含他克莫司(tacrolimus,FK506)或环孢素(ciclosporin,CsA)三联抗排斥治疗,术后6个月内,CD4+计数420×106/L(正常参考值420×106/L～890×106/L)和(或)CD4+/CD8+比值0.82(正常参考值0.82～1.69)。30例随机分为预防治疗组(预防组)、免疫抑制剂减量组(减量组)和对照组3组,每组各10例。预防组在维持原治疗方案的同时予复方磺胺甲唑(SMZ-TMP)每日2片,连用1个月,7例加用更昔洛韦0.5g/d,连用14d,3例加用缬更昔洛韦治疗,900mg/d,连用3个月;减量组根据FK506或CsA血药浓度调整剂量;对照组维持原治疗方案。术后1年为观察终点。结果除减量组4例患者自行退出外,其余患者均完成实验。预防组无发生机会感染,1例出现一过性肾功能损害。对照组1例于术后92d感染巨细胞病毒(cytomegalovirus,CMV)病、另1例术后116d确诊卡氏肺孢子虫肺炎,经治疗痊愈。减量组2例分别于减量后13d、21d发生排斥反应,经甲泼尼龙冲击逆转,另1例于减量后20d经病理证实亚临床排斥反应。结论肾移植术后CD4+计数和(或)CD4+/CD8+比值较低的患者易发生机会感染,予预防治疗可有效降低机会感染的几率,且安全性好。免疫抑制剂减量存在发生排斥反应的风险。     

肾移植术后肺部感染的诊治

随着同种异体肾移植的开展和免疫抑制剂的广泛使用,肾移植术后发生感染的患者越来越多,我们就肾移植术后肺部感染的诊断和治疗进行综述.     

肾移植术后长时间发热原因分析

分析肾移植术后24例长时间发热病例资料,并结合国内外文献对此类患者的发病特点,诊断及治疗体会进行了探讨,认为肾移植术后长时间发热与激素冲击治疗。CsA浓度过高及粒细胞下降有关;感染主要发生在肾移植术后早期(1个月内)及中期(1—6个月),机会感染的发生率较高,CMV感染应引起重视;对肾移植术后长时间发热的病例检查手段应全面,对病因不明的病例应采用多种抗生素联合治疗。     

Clinical characteristics of tuberculous infection following renal transplantation

ObjectiveThis study investigated the clinical characteristics of patients with tuberculosis (TB) following renal transplantation (RT) in order to identify markers or signs that can facilitate early diagnosis.MethodsA retrospective analysis was performed on 12 cases of Mycobacterium tuberculosis infection treated at our hospital between 2005 and 2020.ResultsThe incidence of TB after RT at our hospital was 0.9%, and the median postoperative onset time was 22 months. The average age of patients included in our analysis was 44.2 ± 9.4 years; 11 of the 12 patients were male, and most patients had (low) fever as the first or only manifestation. Five patients had respiratory symptoms; 5 had typical computed tomography (CT) presentation; and 2 had a confirmed history of TB. Two sputum smears from 12 patients were positive by acid fast staining, and M. tuberculosis was detected in peripheral blood samples by metagenomic next-generation sequencing (NGS). One patient had a positive result in the purified protein derivative (PPD) test, 7 were positive with the interferon gamma release assay (IGRA), 8/12 patients were confirmed to have TB infection by NGS and 1 was confirmed positive by lung biopsy.ConclusionBecause of the use of immunosuppressive agents, most patients with TB following RT have atypical clinical symptoms and CT findings, and may have a high probability of a false negative result with the traditional PPD test and a low probability of M. tuberculosis detection, making early diagnosis difficult. Therefore, in RT recipients with prolonged fever of unknown origin and unusual clinical manifestations, especially those who are unresponsive to antibiotic treatment, a diagnosis of TB should be considered. The interferon gamma release assay and NGS are relatively new detection methods with high sensitivity and specificity; these along with regular, repeated testing by various approaches can aid the early diagnosis of TB.     

Wound infection following renal transplantation

A retrospective survey of wound infection following renal transplantation in 100 consecutive patients after the introduction of pre-operative antibiotic prophylaxis is reported. There was one wound haematoma but no wound infection in the 100 primary transplant wounds, and one haematoma which was followed by secondary infection in the 23 patients in whom transplant nephrectomy was performed. There were no other major wound complications. It is concluded that careful surgical technique and antibiotic prophylaxis can virtually eliminate the potentially grave complication of wound infection in this high risk group of patients.     

小剂量万乃洛韦预防肾移植术后CMV感染的临床观察

目的:观察小剂量盐酸万乃洛韦预防肾移植术后巨细胞病毒(CMV)感染的效果,为临床预防肾移植术后CMV感染提供一种有效方法。方法:将47例接受血清学CMV-IgG阳性供肾的血清学阴性受者(D /R-)和59例血清学阳性受者(D±/R )分别随机分为预防组和对照组,肾移植术后第2天预防组口服盐酸万乃洛韦0.6g,每天3次,共服90天;对照组不用任何预防性抗病毒药物。观察预防组和对照组CMV感染、CMV病、急性排斥反应发生情况。结果:万乃洛韦减少了术后CMV感染率及CMV病发病率(P<0.05);万乃洛韦延缓了CMV感染及CMV病的发病时间(P<0.01)。万乃洛韦减少了急性排斥反应的发生率(P<0.05)。结论:对肾移植术后高危受者使用小剂量万乃洛韦是预防CMV感染、减少急性排斥反应的一种有效方法。     

达利珠预防肾移植术后急性排斥反应临床观察

目的探讨达利珠（赛尼哌Zenapax）单剂给药在肾移植受者预防急性排斥反应（AR）的有效性及安全性。方法2003年1月至2005年5月,同期首次肾移植受者90例,随机分为3组：Zenapax单剂组（n=25）,男性15例,女性10例,Zenapax单剂量,术前1h给药;Zenapax双剂组（n=25）,男性15例,女性10例,Zenapax双倍剂量术前1h及术后14d给药;对照组（n=40）,男性24例,女性16例。所有病例均采用环孢素（CsA）加霉酚酸酯（MMF）加皮质类固醇三联免疫抑制方案,观察术后6个月内AR发生情况、肾功能恢复情况、不良反应及感染发生情况。结果单剂及双剂治疗组各有1例患者出现AR,对照组6例出现AR,单剂及双剂组AR的发生率无差异,与对照组比较差异具有统计学意义;两组均未发生细胞因子释放综合征。结论肾移植受者应用Zenapax单剂诱导治疗可降低术后AR发生率,无明显副作用。     

肾移植术后肺部真菌感染的诊治

目的　探讨肾移植术后肺部真菌感染的诊断与治疗。　方法　回顾性分析 4 3例肾移植术后肺部真菌感染患者的临床资料。男 35例 ,女 8例 ,平均年龄 32岁。发病时间平均为术后 5 9d。　结果　 4 3例患者中 ,白色念珠菌 16例 ,克柔念珠菌 4例 ,近平滑念珠菌 2例 ,曲霉菌 4例 ,毛霉菌 3例 ,新型隐球菌 1例 ,奴卡菌 2例 ,其中 14例有细菌、巨细胞病毒混合感染。 11例培养阴性。氟康唑10 0mg/次 ,3次 /d ,连续 10d ,治愈 2 3例 ;两性霉素B脂质体 5 0mg/d ,连续 10d ,治愈 17例 ;死亡 3例。　结论　肺部真菌感染是肾移植术后的严重并发症 ,死亡率高。早期诊断与治疗效果良好。     

肾移植术后肺部感染状态下免疫抑制剂的调整

目的 探讨肾移植术后肺部感染患者免疫抑制剂的应用与预后的关系.方法 对肾移植术后合并肺部感染的98例患者临床资料进行回顾性分析.将患者分为维持应用免疫抑制剂组(维持剂量组,45例)与免疫抑制剂减量或停用组(调整剂量组,53例).按与感染相关的器官衰竭估计评分(SOFA)标准,在肾移植术后肺部感染较重(SOFA≥12分)和感染较轻(SOFA＜12分)的情况下,分别分析两组患者的死亡率、感染恢复时间和排斥反应发生率的差异.结果 当SOFA≥12分时,调整剂量组死亡率和感染恢复时间明显低于维持剂量组(P＜0.05),而排斥反应发生率在两组之间的差异则无统计学意义(P＞0.05);当SOFA＜12分时,死亡率和感染恢复时间在两组之间差异无统计学意义(P＞0.05),但调整剂量组患者排斥反应发生率明显高于维持剂量组(P＜0.05).结论 在肾移植术后肺部感染较重(SOFA≥12分)时,减量和停用免疫抑制剂有利于降低患者的死亡率和缩短抗感染疗程;但感染较轻(SOFA＜12分)时,建议维持免疫抑制剂原剂量不变.     

肾移植术后恶性肿瘤的临床分析

目的总结并分析肾移植患者并发恶性肿瘤的临床特点,探讨其诊治方法。方法回顾性分析1998年至2003年间肾移植患者中发生恶性肿瘤的病例。结果在1293例肾移植患者中,29例发生恶性肿瘤,发病率2.24%(29/1293)。其中泌尿系统肿瘤23例(包括移植肾肾癌1例),胃癌、直肠癌各2例,肝细胞癌、胰腺癌各1例。23例患者行手术治疗,术后15例肿瘤复发。结论肾移植术后恶性肿瘤发病率明显升高,其中泌尿系统肿瘤居多;对移植后出现肿瘤类型的不同可采用不同的治疗方法。     

肾移植术后并发尿路上皮肿瘤的临床分析

目的 分析肾移植患者并发尿路上皮肿瘤的特点，探讨其诊治方法。方法 自1998～2003年肾移植患者1293例，术后发生尿路上皮恶性肿瘤21例（1．6％）。男4例，女17例。17例原发病为慢性问质性肾炎。发生尿路上皮肿瘤距肾移植6～62个月，平均26个月。其中膀胱癌6例，单侧肾盂或输尿管癌6例，单侧肾盂或输尿管、膀胱癌8例，双侧肾盂输尿管癌1例。10例上尿路肿瘤发生部位与移植肾同侧，4例发生于移植肾对侧。临床症状以无痛性肉服血尿和反复泌尿系感染为主。19例行手术治疗，术后所有患者免疫抑制剂用量减少1／3并辅以局部灌注化疗。结果 2例行姑息性治疗的晚期肿瘤患者分别于发现肿瘤5、8个月死亡。余19例现已随访2～5年。13例肿瘤复发，复发部位为膀胱或对侧原。肾、输尿管。所有患者在免疫抑制剂减量期间均未出现急性排斥。2例因切除移植肾恢复透析，17例肾功能正常。结论 慢性间质性。肾炎导致。肾功能衰竭的。肾移植患者和女性肾移植患者易发生移植后尿路上皮肿瘤；移植肾同侧上尿路较对侧好发肿瘤；对移植肾对侧为首发的上尿路发生肿瘤者可预防性行双侧上尿路根治性切除。     

Pamidronate therapy as prevention of bone loss following renal transplantation

BACKGROUND: Very rapid bone loss, osteopenia and skeletal morbidity after renal transplantation have been well documented and found to occur in a sex dependent fashion. Glucocorticoids, cyclosporine and pre-existing uremic osteodystrophy have been implicated in the pathogenesis of the skeletal lesions. Glucocorticoid induced osteopenia is also a serious clinical problem in patients with various nonrenal diseases and can be prevented, or at least attenuated, by pamidronate and other bisphosphonates. METHOD: We prospectively studied 26 male patients undergoing renal transplantation, and randomized them to receive either placebo or intravenous pamidronate (0.5 mg/kg) at the time of transplantation and again one month later. All patients received immunosuppression comprising prednisolone, cyclosporine and azathioprine. The bone mineral density (BMD) of the second, third and fourth lumbar vertebrae and of the femoral neck was measured at the time of transplantation and at three months and 12 months after transplantation using dual energy X-ray absorptiometry (DXA). RESULTS: Twelve months after transplantation, the mean (+/- SEM) BMD of the lumbar vertebrae in patients who received placebo had decreased 6.4% (P < 0.05). In contrast, patients who received pamidronate experienced no significant reduction of BMD at the lumbar vertebrae. At the femoral neck, placebo-treated patients showed a reduction of BMD of 9% (P < 0.005), whereas there was no significant change in the pamidronate treated group. The two study groups had similar patient profiles, serum parathyroid hormone (PTH) and aluminium concentrations. After transplantation, comparable falls in the serum creatinine and PTH concentration were found in the two groups. Apart from transient hypocalcemia in two patients, no significant adverse effects of pamidronate were noted. CONCLUSION: This study has shown that the early rapid bone loss that occurs in men during the first 12 months after renal transplantation can be prevented by two intravenous doses of pamidronate given at transplantation and one month later. The regimen was simple to administer, well tolerated and potentially applicable to other clinical groups of glucocorticoid treatment patients.