肾移植后采用巴利昔单抗诱导治疗时的感染及预防

Objective To investigate the incidence of infection and the effect of anti-infection prophylaxis in renal transplanted patients after Basiliximab induction therapy. Methods A total of 204patients who have received renal transplantation and Basiliximab induction therapy from January 1,2001 to December 31, 2010 in our hospital have been retrospective analysed in this study. These patients were divided into a prophylaxis group (118 cases) with Ganciclovir + Sulfadiazine +Trimethoprim therapy and a control group (86 cases) without any anti-infection prophylaxis.Furthermore, 440 transplanted patients in the same peroid without any induction therapy were also analysed. They were also devided into two groups: an anti-infection prophylaxis group (206 cases)and a control group (234 cases) without any anti-infection prophylaxis. Results In the prophylaxis group with Basiliximab induction therapy, there were 23 patients (19. 5 %, 23/118)experienced hospitalization due to infection, 3 cases (13. 0 %,3/23) among them were severe infection, and 3patients (13.0 %, 3/23) died from vital infection. In the non-prophylaxis control group with Basiliximab induction therapy, 27 patients (31.4 %, 27/86) had infection complication, 7 patients (25.9 % ,7/27) among them were severe infection, and 4 patients(14. 8 % ,4/27)died. The incidence of infection between the above two groups is significantly different (P＜0. 05). In the prophylaxis group without induction therapy, the incidence of infection was 15.0 % (31/206), there were no severe infection cases but 7 patients (22. 6 %, 7/31) died from infection. In the non-prophylaxis control group without induction therapy, the incidence of infection was 12. 8 % (30/234), 3 cases among them were severe infection(10. 0 %,3/30)and 5 patients died from infection (16. 7 %, 5/30).The incidence of infection in Basiliximab induced patients without anti-infection prophylaxis is significantly higher than that in patients without induction therapy and anti-infection prophylaxis (31.4 % vs. 12.8 %,P＜0.01). Conclusion Basiliximab induction therapy increased the risk of infection, but not the rate of mortality. It is necessary to give anti-infection prophylaxis in renal transplanted patients with Basiliximab induction therapy.     

肾移植后采用巴利昔单抗诱导治疗时的感染及预防

Objective To investigate the incidence of infection and the effect of anti-infection prophylaxis in renal transplanted patients after Basiliximab induction therapy. Methods A total of 204patients who have received renal transplantation and Basiliximab induction therapy from January 1,2001 to December 31, 2010 in our hospital have been retrospective analysed in this study. These patients were divided into a prophylaxis group (118 cases) with Ganciclovir + Sulfadiazine +Trimethoprim therapy and a control group (86 cases) without any anti-infection prophylaxis.Furthermore, 440 transplanted patients in the same peroid without any induction therapy were also analysed. They were also devided into two groups: an anti-infection prophylaxis group (206 cases)and a control group (234 cases) without any anti-infection prophylaxis. Results In the prophylaxis group with Basiliximab induction therapy, there were 23 patients (19. 5 %, 23/118)experienced hospitalization due to infection, 3 cases (13. 0 %,3/23) among them were severe infection, and 3patients (13.0 %, 3/23) died from vital infection. In the non-prophylaxis control group with Basiliximab induction therapy, 27 patients (31.4 %, 27/86) had infection complication, 7 patients (25.9 % ,7/27) among them were severe infection, and 4 patients(14. 8 % ,4/27)died. The incidence of infection between the above two groups is significantly different (P＜0. 05). In the prophylaxis group without induction therapy, the incidence of infection was 15.0 % (31/206), there were no severe infection cases but 7 patients (22. 6 %, 7/31) died from infection. In the non-prophylaxis control group without induction therapy, the incidence of infection was 12. 8 % (30/234), 3 cases among them were severe infection(10. 0 %,3/30)and 5 patients died from infection (16. 7 %, 5/30).The incidence of infection in Basiliximab induced patients without anti-infection prophylaxis is significantly higher than that in patients without induction therapy and anti-infection prophylaxis (31.4 % vs. 12.8 %,P＜0.01). Conclusion Basiliximab induction therapy increased the risk of infection, but not the rate of mortality. It is necessary to give anti-infection prophylaxis in renal transplanted patients with Basiliximab induction therapy.     

肾移植后采用巴利昔单抗诱导治疗时的感染及预防

目的 探讨肾移植后采用巴利昔单抗诱导治疗时的感染发生情况以及采取感染预防措施的效果.方法 回顾分析2001年1月至2010年12月间肾移植后接受巴利昔单抗诱导治疗者的资料,共有204例患者人选,其中118例采取感染预防措施(预防组),余下86例未行感染预防(对照组).同期440例未接受巴利昔单抗以及其他抗体类制剂的肾移植受者,其中234例未采取感染预防措施(无诱导对照组),206例采取了感染预防措施(无诱导预防组).诱导治疗方案为移植术前2 h和术后第4天各滴注巴利昔单抗20mg,感染预防方案为更昔洛韦+联磺甲氧苄啶.分析感染并发症与抗体治疗的关系以及预防感染的效果.结果 204例应用巴利昔单抗诱导治疗者中,预防组23例(19.5%,23/118)因感染需住院治疗,其中重症病例3例(13.0%,3/23),因感染死亡3例(13.0%,3/23);对照组为27例(31.4%,27/86)因感染需住院治疗,其中重症病例7例(25.9%,7/27),因感染死亡4例(14.8%,4/27);预防组和对照组感染发生率的差异有统计学意义(P＜0.05),两组间重症感染率的差异有统计学意义(P＜0.05),而死亡率的差异无统计学意义(P＞0.05).同期肾移植后未行抗体诱导治疗440例,无诱导预防组感染发生率为15.0%(31/206),无重症病例,因感染死亡7例(22.6%,7/31);无诱导对照组感染发生率为12.8%(30/234),其中重症病例3例(10.0%,3/30),因感染死亡5例(16.7%,5/30).在未采取感染预防措施的情况下,采用抗体诱导治疗者的感染发生率(31.4%)明显高于无诱导者(12.8%),差异有统计学意义(P＜0.01).结论 肾移植后应用巴利昔单抗诱导治疗存在感染风险,但不增加死亡率;联合采取感染预防措施可以降低感染发生率和重症感染率,能有效预防感染并发症.

Abstract：

Objective To investigate the incidence of infection and the effect of anti-infection prophylaxis in renal transplanted patients after Basiliximab induction therapy. Methods A total of 204patients who have received renal transplantation and Basiliximab induction therapy from January 1,2001 to December 31, 2010 in our hospital have been retrospective analysed in this study. These patients were divided into a prophylaxis group (118 cases) with Ganciclovir + Sulfadiazine +Trimethoprim therapy and a control group (86 cases) without any anti-infection prophylaxis.Furthermore, 440 transplanted patients in the same peroid without any induction therapy were also analysed. They were also devided into two groups: an anti-infection prophylaxis group (206 cases)and a control group (234 cases) without any anti-infection prophylaxis. Results In the prophylaxis group with Basiliximab induction therapy, there were 23 patients (19. 5 %, 23/118)experienced hospitalization due to infection, 3 cases (13. 0 %,3/23) among them were severe infection, and 3patients (13.0 %, 3/23) died from vital infection. In the non-prophylaxis control group with Basiliximab induction therapy, 27 patients (31.4 %, 27/86) had infection complication, 7 patients (25.9 % ,7/27) among them were severe infection, and 4 patients(14. 8 % ,4/27)died. The incidence of infection between the above two groups is significantly different (P＜0. 05). In the prophylaxis group without induction therapy, the incidence of infection was 15.0 % (31/206), there were no severe infection cases but 7 patients (22. 6 %, 7/31) died from infection. In the non-prophylaxis control group without induction therapy, the incidence of infection was 12. 8 % (30/234), 3 cases among them were severe infection(10. 0 %,3/30)and 5 patients died from infection (16. 7 %, 5/30).The incidence of infection in Basiliximab induced patients without anti-infection prophylaxis is significantly higher than that in patients without induction therapy and anti-infection prophylaxis (31.4 % vs. 12.8 %,P＜0.01). Conclusion Basiliximab induction therapy increased the risk of infection, but not the rate of mortality. It is necessary to give anti-infection prophylaxis in renal transplanted patients with Basiliximab induction therapy.     

肾移植后因免疫抑制剂的不良反应转换应用咪唑立宾的效果

Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.     

肾移植后因免疫抑制剂的不良反应转换应用咪唑立宾的效果

Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.     

218例巨大胆总管结石病人临床诊疗分析

Objective To investigate the clinical situation, laboratory examination, endoscopic therapy and complications in 218 patients with huge choledocholith. Methods A total of 218 patients with choledocholith were enrolled in the observational group (diameter≥2 cm), They were then sub-divided into the 1stone group, 2 stone group and >2 stone group according to the stone number. The other 231 patients with choledocholith were regarded as control group(diameter<2 cm). The history information, clinical situation, laboratory examination, endoscopic therapy and complications in all the patients were analyzed. Results The ratio of patients with history of biliary infection and choledocho-lithotomy was significantly higher in the observational group than in the control(26.6%, 35.6% ver-sus 15.2 %, 7.8 %). And the ratio of patients with history of acute pancreatitis was markedly lower in the former than in the latter group (9.6% vs 16.9%). In 2 stone group and >2 stone group, the inci-dence of abdominalgia and fever was higher than that in the control group significantly(88%, 94.2% vs 74.5% ,64%, 65.4% vs 41.6%). The incidence of jaundice and diarrhea was remarkably higher in >2 stone group than in the control group(78.8% vs 51.1% ,44.2% vs 26.8%). In 2-stone group and >2-stone group, the serum levels of TA, AKP, γ-GT were significantly increased as compared with the control group. Meanwhile, the serum levels of total bilirubin and direct bilirubin were markedly higher in >2 stone group than in the control group. After operation, the serum levels of total biliru-bin, direct bilirubin and AKP were reduced as compared with those before operation. The total and one-time success rate of endoscopic stone extraction was remarkably lower in 2 stone group and >2 stone group than in the control(88%, 79% vs 94% ,72%, 56% vs 82%). The mean duratgion of hos-pitalization was much higher than control group (13±4.6, 16±5.2 vs 10±3.8). In >2 stone group, the incidence of stone obstruction, papilla bleeding and arrhythmia was significantly increased as com-pared with the control group in the course of operation(21%, 33 %, 15 % vs 6.9 %, 19 %, 9 %). In 2 stone group and >2 stone group, the incidence of acute pancreatitis after operation was significantly higher than that in the control group(15%, 23% vs 7. 4%). The incidence of hyperamylasemia after op-eration was significantly higher than that in the control group in >2 stone group(17% vs 6%). Conclusion Repeated biliary infection and choledocholithotomy have close relation with huge choledocholith. Jaundice, diarrhea and lesion of liver function occur more easily in the patients with huge choledocholith, and the endo-scopic therapy is more difficult. Complications occur much easily during and after operation.     

肾移植后因免疫抑制剂的不良反应转换应用咪唑立宾的效果

Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.     

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

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.     

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

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.     

CT finding is an index in assessment of outcome in patients with diffuse traumatic brain swelling

Objective:To assess the relationship between the prognosis of the patients with diffuse traumatic brain swelling (DTBS) and the changes of the ventricles and the cisterns in CT scans.Methods:The outcome of the patients with DTBS and the changes of the vertricles and the cisterns in CT scans were studied and analyzed in a group of 268 cases.We focused on the changes of the third ventricle and the basal cistern,age and Glasgow Coma Scale(GCS).Results:Of 268 cases,there were changes of the third ventricle and/or the basal cistern in 124,65 died.In 18 cases,the third ventricle and the basal cistern were both absent and 16 died(88.9%).The third ventricle changed significantly in 59 cases,33 died(55.9%),while the basal cistern changed in 47 cases and 16 died (34%).Of the 124 patients with changes of the third ventricle and/or the basal cistern,26 were children,8 died;98 adults,57 died.Conclusions:For patients with DTBS,the outcome was in direct correlation with the change of the third ventricle and/or the basal cistern,the change of the third ventricle was much more important in assessment of the outcome than that of basal cisterns.There is no significant difference in,the incidence of DTBS between children and adults while the outcome of children is much better than that of adults.The patients with the changes of the third vertricle and the basal cistern accompanied with lower GCS scores have poor outcome.