肝移植后泛耐药鲍曼不动杆菌感染者的细胞免疫功能监测和免疫抑制方案调整

目的 探讨肝移植后泛耐药鲍曼不动杆菌(PDR-Ab)感染者的细胞免疫功能监测及免疫抑制方案的调整.方法 回顾性总结2008年1月至2010年5月299例尸体肝移植病例并发PDR-Ab的感染和预后情况.监测肝移植后T淋巴细胞亚群及绝对计数、CD4+T淋巴细胞ATP含量,进行T淋巴细胞免疫功能评分.将14例发生PDR-Ab感染者根据免疫抑制方案的调整不同分为2组,常规治疗组(6例)的他可莫司用量不变,停用吗替麦考酚酯和泼尼松,给予头孢哌酮钠/舒巴坦钠静脉滴注;免疫调节组(8例)在常规治疗的基础上,根据受者的T淋巴细胞免疫功能评分(TCIFS)的动态变化进行免疫抑制方案的调整.结果 两组间受者的年龄、终末期肝病模型评分、Child-Pugh评分的差异均无统计学意义(P＞0.05);术中出血量的差异有统计学意义(P＜0.01);术后1周、发生PDR-Ab感染时TCIFS的差异无统计学意义(P＞0.05),但在治疗终点,免疫调节组的TCIFS明显高于常规治疗组(P＜0.05);两组间治愈率的差异有统计学意义(P＜0.05).2个组均未发生排斥反应.结论 肝移植后并发PDR-Ab感染时,根据T淋巴细胞亚群计数和CD4+T淋巴细胞ATP值对肝移植受者的细胞免疫功能进行量化评分,以进行免疫抑制方案的调整,是降低肝移植后PDR-Ab感染病死率的有效方法.

Abstract：

Objective To explore the monitoring and the individualized adjustment of cellular immunology function in the recipients infected with pan-drug resistant Acinetobacter baumannii(PDR-Ab)after liver transplantation.Methods We retrospectively summarized the infection and the prognosis of PDR-Ab in 299 cases of liver transplantation performed from Jan.2008 to May 2010.The absolute number of T lymphocytes and ATP level within CD4+ T cells were monitored,and T cell immunology function(TCIFS)was scored.According to different immunology adjusting proposals,14 cases of PDR-Ab infection were divided into 2 groups:(1)traditional group,routine anti-infective therapy;(2)individualized group.Individualized immunology adjustment was made according to the score of TCIFS besides routine therapy.Results There was no significant difference in age,MELD and Child-pugh score between two groups.The peri-operative bleeding volume in individualized group was more than that in traditional group(P<0.01).There was no significant difference in TCIFS score between two groups at 1st week after transplantation and the onset of the PDR-Ab infection.However,the score in individualized group was apparently higher than that in traditional group when anti-infection therapy ended(P<0.05).The difference in the recovery rate between two groups was significant(P<0.05).No rejection happened in two groups.Conclusion It is an effective way to decrease the mortality of PDR-Ab infection after liver transplantation that the individualized adjustment of immunosuppression protocols is guided by grading quantitatively the cellular immunology function according to the absolute number of T lymphocytes and ATP level within CD4+ T cells.

Cellular immunology function test and individualized immunology adjustment of pan-drug resistant Acinetobacter baumannii infected patients after liver transplantation

Objective To explore the monitoring and the individualized adjustment of cellular immunology function in the recipients infected with pan-drug resistant Acinetobacter baumannii(PDR-Ab)after liver transplantation.Methods We retrospectively summarized the infection and the prognosis of PDR-Ab in 299 cases of liver transplantation performed from Jan.2008 to May 2010.The absolute number of T lymphocytes and ATP level within CD4+ T cells were monitored,and T cell immunology function(TCIFS)was scored.According to different immunology adjusting proposals,14 cases of PDR-Ab infection were divided into 2 groups:(1)traditional group,routine anti-infective therapy;(2)individualized group.Individualized immunology adjustment was made according to the score of TCIFS besides routine therapy.Results There was no significant difference in age,MELD and Child-pugh score between two groups.The peri-operative bleeding volume in individualized group was more than that in traditional group(P<0.01).There was no significant difference in TCIFS score between two groups at 1st week after transplantation and the onset of the PDR-Ab infection.However,the score in individualized group was apparently higher than that in traditional group when anti-infection therapy ended(P<0.05).The difference in the recovery rate between two groups was significant(P<0.05).No rejection happened in two groups.Conclusion It is an effective way to decrease the mortality of PDR-Ab infection after liver transplantation that the individualized adjustment of immunosuppression protocols is guided by grading quantitatively the cellular immunology function according to the absolute number of T lymphocytes and ATP level within CD4+ T cells.