实用器官移植电子杂志 ›› 2013, Vol. 1 ›› Issue (2): 95-102.

• 论著 • 上一篇    下一篇

肾移植术后间质性肺炎的早期诊断、预防及处理原则

董彪,王钢,王伟刚,王远涛,周洪澜,傅耀文
  

  1. 吉林大学第一医院泌尿系统疾病诊治中心,吉林 长春 130021
  • 出版日期:2013-03-20 发布日期:2021-04-20
  • 基金资助:

    国家自然科学基金青年基金(81102237);

    吉林省国家自然科学基金(201215047,201115057)

Early diagnosis,prophylaxis and treatment of interstitial pneumonia after renal transplantation

DONG Biao,WANG Gang,WANG Wei-gang,WANG Yuan-tao,ZHOU Hong-lan,FU Yao-wen.
  

  1. The UrinaryDisease Diagnosis & Treatment Centre,the First Hospital of Jilin University,Changchun 130021,Jilin,China
  • Online:2013-03-20 Published:2021-04-20

摘要:

目的 探讨肾移植术后间质性肺炎的早期诊断、预防及处理原则。方法 选择吉林大学第一医院泌尿系统疾病诊治中心 2008 年至 2011 年肾移植术后出现间质性肺炎患者 83 例。比较 2008 年 1-12 月与 2009 年 1 月 -2011 年 12 月两个时期肾移植患者术后预防及治疗的差异,以及间质性肺炎的发生情况。结果 2008 年 1-12 月 138 例患者进行肾移植,术后发生间质性肺炎 38 例,发生率为 27.54% ;2009-2011年 435 例患者行肾移植,45 例术后发生间质性肺炎,发生率为 10.34%。2008 年组肾移植术后患者早期住院期间给予静脉注射更昔洛韦针剂,出院后口服更昔洛韦片剂及复方新诺明片剂。2009-2011 年组肾移植术后患者出院后根据患者血药浓度及血肌酐水平给予口服更昔洛韦片剂及复方新诺明片剂。在患者检查肺部 CT 确诊为间质性肺炎后入院,2008 年组采取根据患者的病情减少或停用免疫抑制剂,给予适量糖皮质激素冲击、更昔洛韦抗病毒及联合复方新诺明抗原虫治疗 ;2009-2011 年组则采取根据患者的病情情况使用规律性大剂量糖皮质激素冲击,并停用免疫抑制剂,同时抗病毒及联合复方新诺明抗原虫治疗。2008 年组治愈 / 好转 35 例,死亡 2 例,1 例放弃治疗,治疗期间发生排异反应 3 例。2009-2011 年组治愈 / 好转45 例,死亡 0 例,治疗期间发生排异反应 3 例。2008-2011 年 573 例肾移植术患者中,接受巴利昔单抗或抗胸腺细胞球蛋白(ATG)等抗体诱导治疗 183 例,未接受抗体诱导治疗 390 例 ;在 83 例肾移植术后发生间质性肺炎患者中,有 27 例患者应用巴利昔单抗或 ATG 等抗体诱导治疗,其余 56 例未接受抗体诱导治疗。结论 ①早期停用免疫抑制剂、给予糖皮质激素冲击治疗、更昔洛韦抗巨细胞病毒治疗、联合应用复方新诺明抗原虫治疗及有效的营养支持是治疗肾移植术后治疗间质性肺炎的有力措施。②在有效的肾移植术后预防间质性肺炎用药指导下,肾移植患者术前接受抗体诱导治疗未见其增加术后发生间质性肺炎的概率。

关键词:

Abstract:

Objective To investigate the early diagnosis,prophylaxis and treatment principles ofinterstitial pneumonia in renal transplant recipients. Methods 83 kidney transplant recipients who diagnosed withinterstitial pneumonia during the period from 2008 to 2011 in the Urinary Diseases Diagnosis & Treatment Center,First Hospital of Jilin University were enrolled in this study. The difference of prophylaxis,treatment with interstitialpneumonia and the occurrence of interstitial pneumonia after renal transplantation between January - December,2008 and January 2009 - December 2011 were compared. Results There were a total of 138 patients underwentallograft renal transplantation during the period from January 2008 to December 2008,and 38 of the kidney recipientsdeveloped interstitial pneumonia and the incidence rate was 27.54%. There were a total of 435 patients underwent
allograft renal transplantation during the period from January 2009 to December 2011,and 45 of the kidney recipientsdeveloped interstitial pneumonia and the incidence rate was 10.34%. Kidney transplant recipients during the period from January 2008 to December 2008 received intravenous ganciclovir during the hospital stay and oral ganciclovirin the post-discharge period. Kidney transplant recipients during the period from January 2009 to December 2011 received oral ganciclovir and trimethoprim
-sulfamethoxazole(SMZ-TMP)in the post-discharge period accordingto the plasma concentration and the level of serum creatinine. When diagnosed with interstitial pneumonia bypulmonary CT,the immunosuppressive drugs of the recipients during the period from January 2008 to December2008 were reduced or withdrew,and corticosteroid therapy,ganciclovir resistant cytomegalovirus(CMV)treatment,combination with the cotrimoxazole antiprotozoal treatment were given. The recipients during the period from January2009 to December 2011 were received regular high-dose corticosteroid and withdrew the immunosuppressive drugs,given ganciclovir resistant CMV treatment with combination of cotrimoxazole antiprotozoal treatment. In the group of recipients during the period from January 2008 to December 2008,35 cases were cured/improved,2 cases died,1 case abandoned treatment and 3 cases developed rejection reaction during the treatment period. In the group ofrecipients during the period from January 2009 to December 2011,45 cases were cured/improved,no case died and 3cases developed rejection reaction during the treatment period. There were a total of 573 patients underwent allograft renal transplantation during the period from 2008 to 2011,among who 183 patients received antibody inductiontherapy including basiliximab or antithymocyte globulin(ATG),and the other 390 patients did not receive. Among 83patients who developed interstitial pneumonia after kidney transplantation,27 patients received antibody inductiontherapy including basiliximab or ATG,while 56 patients did not receive. Conclusions Early discontinuationof immunosuppressive agents and given corticosteroid therapy,ganciclovir resistant CMV treatment,combinationthe cotrimoxazole antiprotozoal treatment and effective nutrition support therapy were effective in the treatmentof interstitial pneumonia after renal transplantation. In addition,under effective medication guide for interstitial pneumonia prevention after renal transplantation,kidney transplant patients' occurrence of interstitial pneumonia was not significantly associated with their use of antibody induction therapy.

Key words: