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目的探讨胸腺肽α1(商品名日达仙)对肾移植术后并发巨细胞病毒(CMV)肺炎患者的治疗作用。方法根据CMV感染后是否使用日达仙将CMV肺炎患者分为两组:观察组(22例)和对照组(14例)。两组患者均采用同样的免疫抑制剂调整方案,针对性抗病毒、细菌或抗真菌和支持治疗。在此基础上,观察组加用日达仙治疗(日达仙1.6 mg,皮下注射,隔日1次或每天1次)。根据外周血白细胞计数及其分类和CD4~+、CD8~+ T淋巴细胞水平调整其用量及次数。比较两组患者抢救成功率、病死率和移植肾有无急性排斥反应发生,以及外周血白细胞计数、淋巴细胞计数、T细胞亚群的变化。结果观察组的抢救成功率明显高于对照组,分别为77.3%和50.0%;病死率显著下降,分别为22.7%和50.0%。日达仙治疗后患者临床症状明显改善,外周血白细胞、淋巴细胞及CD4~+、CD8~+淋巴细胞计数和CD4~+/CD8~+细胞比值均有增高。结论肾移植术后合并CMV肺炎患者加用日达仙、撤停主要免疫抑制剂可提高CMV肺炎并发急性呼吸窘迫综合征的抢救成功率,降低其病死率。这可能与日达仙调节T淋巴细胞数量和功能,提高机体细胞免疫功能,增强抗感染能力有关。随着病情的好转,机体免疫功能不断恢复和重建,应注意适时加用免疫抑制剂,谨防急性排斥反应的发生。
Objective To investigate the therapeutic effect of thymosin α1 (trade name Zadaxin) on patients with cytomegalovirus (CMV) pneumonia after renal transplantation. Methods CMV pneumonia patients were divided into two groups according to whether or not Zadaxin was used after CMV infection: observation group (22 cases) and control group (14 cases). Both groups adopted the same immunosuppressive regimen, targeted antiviral, bacterial or antifungal and supportive care. On this basis, the observation group plus daily treatment (daily up to 1.6 mg, subcutaneous injection, every other day or once daily). According to the peripheral blood leukocyte count and its classification and CD4 ~ +, CD8 ~ + T lymphocyte levels to adjust the amount and frequency. Rescue success rate, case fatality rate and acute rejection of renal allograft were compared between the two groups. The changes of peripheral blood leukocyte count, lymphocyte count and T cell subsets were also compared. Results The success rate of rescue in the observation group was significantly higher than that in the control group (77.3% and 50.0% respectively), and the mortality rate was significantly decreased to 22.7% and 50.0% respectively. The clinical symptoms of patients treated with Zadaxin were significantly improved. The numbers of peripheral blood leucocytes, lymphocytes and CD4 ~ +, CD8 ~ + lymphocytes and CD4 ~ + / CD8 ~ + cells increased. Conclusions Renal transplant patients with CMV pneumonia combined with Zadaxin and withdrawal of major immunosuppressive agents can improve the success rate of rescue and reduce the mortality of CMV pneumonia complicated with ARDS. This may be associated with the daily dose of T lymphocytes and function, improve the body’s cellular immune function, enhance the ability of anti-infection. With the improvement of the condition, the body’s immune function continues to recover and reconstruction, should pay attention to the timely addition of immunosuppressive agents, beware of the occurrence of acute rejection.