Clinical Analysis Of Stopping Immunosuppressants Combined With Human Immunoglobulin In Treating Pulmonary Fungal Infection After Renal Transplantation

Objective:Giving into account the clinical cases,this study is to investigate the safety and efficacy of the discontinuation immunosuppressive agents combined with the using of human immunoglobulin for the treatment of pulmonary fungal infection in patients after renal transplantation.Methods:The clinical data of 22 patients with pulmonary fungal infection after renal transplantation admitted to the Urology Department of Qianfoshan Hospital,Shandong province from January 2014 to December 2015 were collected,and this group of patients was labeled as group A.The patients in this group were treated with routine antifungal therapy,that is,on the basis of antifungal drug treatment,immunosuppressants were gradually reduced to the maintenance amount,and human immunoglobulin was not used.Collect the clinical data of 30 cases of pulmonary fungal infection diagnosed by renal transplantation patients from January 2016 to December 2017,and mark this group as group B.These patients adopted the same kind of antifungal therapy as group A,and stopped all immunosuppressant drugs in early treatment and gave human immunoglobulin treatment.Collect the clinical data of two groups of patients,including sex,age,onset time,symptoms,pathogen examination,laboratory examination,imaging examination,disease prognosis after antifungal therapy,and make statistical analysis on the collected related data.Results1 The duration of disease in group A was longer than that in group B,the difference was statistically significant(P<0.05).There was no statistically significant difference in sex,age and morbidity between groups(P>0.05).2 The onset time of patients in group A was 20-166 days after operation,with an average of 45 days.Among them,17 cases were within 3 months after renal transplantation,and 5 cases were within 3 to 6 months after operation.30 patients in group B had a onset time of 24-162 days after operation,with an average of 47 days,including 22 cases occurring 3 months after renal transplantation and 8 cases occurring 3-6 months after renal transplantation.There was no statistically significant difference in the incidence time between the two groups(P>0.05).3 In terms of clinical symptoms and signs,the data of two groups were compared.There were more patients with low fever in group B than in group A(P<0.05),and there were no statistical differences in middle fever,dyspnea,cough,signs and finger pulse oxygen(P>0.05).4 There were 14 cases with diffuse ground glass-like changes in group A,10 cases with patchy shadows,5 cases with nodular shadows and 2 cases with cavitary shadows.There were 17 cases of diffuse ground glass-like changes in group B,14 cases of patchy shadows,7 cases of nodular shadows and 3 cases of cavitary shadows.There were more diffuse ground glass shadows in group A than in group b,the difference was statistically significant(P<0.05).5 In terms of disease prognosis,among 22 patients in group A,15 cases were effective and 7 cases were ineffective,with the effective rate of 68.2 %.Among the 30 patients in group B,28 cases were effective and 2 cases were ineffective,the effective rate was 93.3 %.The difference between the two groups was statistically significant(P<0.05).6 The results of correlation analysis showed that the effective rate of treatment in group A was negatively correlated with the duration of disease and diffuse pulmonary lesions(P<0.05),and positively correlated with the low fever of patients(P<0.05).The effective rate of treatment in group B was negatively correlated with diffuse pulmonary lesions in patients(P<0.05),and positively correlated with low fever in patients(P<0.05).Conclusion1 The efficacy of stopping immunosuppressants combined with human immunogl obulin in patients with pulmonary fungal infection after renal transplantation is better;2 The effective rate of stopping immunosuppressants combined with human immunoglobulin therapy was negatively correlated with diffuse pulmonary lesions in patients,and positively correlated with low fever in patients(P<0.05)3 It is supposed that stopping immunosuppressants combined with human immunoglobulin in treating pulmonary fungal infection after renal transplantation is expected to be an effective treatment method.