被动免疫治疗在肾移植术后重症肺部感染患者救治中的应用

目的探讨被动免疫治疗在肾移植术后重症肺部感染患者救治中的有效性和安全性。方法对2007年8月至2009年10月间51例肾移植术后重症肺部感染患者(被动免疫组)采用以胸腺肽和丙种球蛋白为主的被动免疫治疗,选取2005年1月至2007年7月间52例肾移植术后重症肺部感染患者作为对照组。两组均采取停用基础免疫抑制剂同时给予广谱、降阶梯抗感染治疗,被动免疫组根据病情加用胸腺肽和丙种球蛋白,监测外周血CD4+淋巴细胞计数变化,并观察患者临床症状、体征及胸部CT变化。结果被动免疫组存活47例,4例死亡,存活率为92.2%(47/51),感染控制时间(12.8±2.7)d,存活患者住院时间为(27.3±7.0)d;对照组存活39例,13例死亡,存活率为75.0%(39/52),感染控制时间(17.7±4.2)d,存活患者住院时间为(36.3±9.1)d。被动免疫组存活率高于对照组,存活患者的感染控制时间和住院时间少于对照组,差异均有统计学意义(P<0.05)。被动免疫组所有患者均未出现急性排斥反应,对照组出现4例。被动免疫组和对照组存活患者CD4+细胞计数呈上升趋势,两组死亡患者CD4+细胞计数呈下降趋势。结论胸腺肽联合丙种球蛋白的被动免疫治疗,可以有效提高肾移植术后重症肺部感染患者的治愈率、减少病死率,期间监测CD4+细胞计数变化对于指导治疗和预后判断具有重要参考价值。

Application of passive immunotherapy in renal transplant patients with severe pneumonia

ObjectiveTo observe the efficacy and safety of passive immunotherapy for treatment of renal transplant patients with severe pneumonia. MethodsFrom August 2007 to October 2009, 51 patients with severe pneumonia following renal transplantation were treated with passive immunotherapy(thymosin and immunoglobulin), and they were taken as passive immunization group; and the other 52 patients with severe pneumonia following renal transplantation from January 2005 to July 2007 were taken as control group. The basic immunosuppressant was stopped and de-escalation therapy and broad-spectrum anti-infection therapy were given to both groups. Passive immunization group was given thymosin and immunoglobulin according to the patient condition. The peripheral CD4+ T-cell counts, clinical symptoms, signs and chest CT changes were observed in both groups. ResultsThe survival rate of passive immunization group was significantly higher than that of control group (92.2% vs 75.0%, P<0.05).The time of infection control in passive immunization group was significantly shorter than that of control group ([12.8±2.7] d vs [17.7±4.2] d, P<0.05). The length of hospital stay of the survivors was significantly shorter in passive immunization group than in the control group ([27.3±7.0] d vs [36.3±9.1] d,P<0.05). No acute rejection occurred in the passive immunization group, and 4 occurred in the control group. The CD4+ T-cell counts had an increasing tendency in the survivors of both groups and had a declining trend in those who finally died. ConclusionPassive immunotherapy with thymosin and immunoglobulin can improve the survival rate of renal transplant patients with severe pneumonia, and monitoring the variation of CD4+ T-cell counts may play an important role in guiding treatment and predicting prognosis.