摘要
目的探讨肝移植后发生严重感染时细胞免疫功能的动态变化和免疫抑制剂的个体化调整。方法回顾分析378例尸体肝移植的临床资料。术后发生严重感染者74例（感染组），其中54例治愈（治愈组），20例死亡（死亡组），以同期50例肝功能正常，未发生感染和排斥反应的肝移植受者为对照组。测定和比较各组受者T淋巴细胞亚群及绝对计数的变化。另根据免疫抑制剂个体化调整策略的不同，将感染组受者分为常规调节组（53例）和个体化调节组（21例），观察免疫抑制方案个体化调整后的疗效。结果与对照组比较，其他3组术前终末期肝病模型（MELD）评分和术中出血量均明显较高（P〈0．05）；且死亡组均显著高于感染组和治愈组（P〈0．05）。对照组术后1周到出院时，淋巴细胞和CD^4T淋巴细胞计数均明显升高（P〈O．01）。与对照组术后1周时比较，感染组术后1周和感染时淋巴细胞和CD^4T淋巴细胞明显较低（P〈0．01）。治愈组感染控制后CD^4T淋巴细胞和淋巴细胞计数较术后1周与感染时明显升高（P〈0．01）。死亡组CD^4T淋巴细胞和淋巴细胞计数持续降低（P〈0．05）。术后1周和感染时，常规调节组和个体化调节组间各免疫指标的差异无统计学意义（P〉0．05），但两组治愈率分别为66．0％（35／53）和90．5％（19／21，P〈0．05），急性排斥反应发生率分别为5．7％（3／53）和0（P〉0．05）。结论淋巴细胞和CD^4T淋巴细胞计数及其动态变化对肝移植术后感染的发生和预后影响较大。根据免疫功能动态变化对严重感染受者个体化调整免疫抑制剂，有助于改善肝移植严重感染者的预后。
Objective To explore the dynamic changes of the cellular immune function in severe infection after liver transplantation, and to guide the individualized immunology adjustment. Methods 378 cases of livertransplantation were analyzed retrospectively. Seventy-four cases （infection group） suffered serious infection, including 54 cases cured （cure group）, 20 cases died （death group）. Fifty cases without infection and rejection were randomly selected as control group （stable group）. According to the individualized adjusting proposal of immunosuppressants, 74 patients with severe infection were divided into two groups： traditional （T） group and individualized （I） group. The general condition, recovery rate and change of cellular immune function pre- and post-treatment were analyzed. Results The preoperative MELD score and the intraoperative blood loss in infection group were significantly higher than stable group, and those in death group were higher than in cure group. CD^4 T lymphocyte counts and lymphocyte counts in stable group were increased significantly from first week post-operation to discharge. The two indicators in infection group at first week post- operation and the onset of infection were lower than in stable group （P〈0. 01）. In cure group after infection was controlled the two indicators were higher than at first week post-operation and the onset of infection （P〈0. 01）, while in death group they were reduced up to death （P〈0. 05）. There was no significant difference in age, preoperative MELD score and the immune function indicators both at first week post-operation and the onset of infection between T group and I group, except the intraoperative blood loss in I group was greater than in T group. The recovery rate in I group（90. 5%）was higher than in T group （66. 0 %）. Conclusion Individualized adjustments of immunosuppressants guided according to the dynamic changes of cellular immune function helped to improve the prognosis of severe infection after li
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2011年第7期411-414,共4页
Chinese Journal of Organ Transplantation
基金
上海市科委科研计划项目（08410701100）
关键词
肝移植
免疫
细胞
感染
Liver transplantation
Immunity, cellular
Infection
