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目的 :观察肾移植术后巨细胞病毒 (CMV)感染合并急性呼吸窘迫综合症 (ARDS)患者CD4 + 、CD8+ T细胞亚群的动态变化 ,了解其与病情进展及预后的关系。 方法 :监测 12例肾移植术后发生CMV感染并发ARDS的患者T细胞亚群的变化 ,分别测定其发生ARDS时、治疗 7天、14天以及好转出院时的外周血CD4 + 、CD8+ T细胞计数和比值 ,取术后 2个月时无急性排斥和感染时的结果作为感染前对照。 结果 :12例患者 ,存活 7例 ,死亡 5例 ,发生ARDS时CD4 + 、CD8+ T细胞计数及比值较感染前显著降低 ,随着病程进展 ,存活组患者CD4 + 、CD8+ T细胞计数在治疗 7天、14天和治疗好转加用免疫抑制剂前不断升高 ,且均显著高于ARDS发生时 ,CD4 + /CD8+ 比值也不断升高 ,治疗 14天时的比值显著高于ARDS发生时。死亡组患者的CD4 + 、CD8+ T细胞计数则呈下降趋势 ,治疗 7天、14天时的CD4 + T细胞计数明显低于存活组 ,CD4 + /CD8+ 比值也保持较低水平。 结论 :在肾移植术后CMV感染并发ARDS患者中 ,CD4 + 、CD8+ 计数及其比值的变化与病情危重程度和预后有一定的相关性 ,可以作为判断病情变化和临床转归的预测指标。上述指标升高表示病情好转 ,预后较好 ,而上述指标持续下降或者保持很低水平则表示机体免疫力极其低下 ,病情危重 ,预后
OBJECTIVE: To observe the dynamic changes of CD4 +, CD8 + T cell subsets in patients with cytomegalovirus (CMV) infection and acute respiratory distress syndrome (ARDS) after renal transplantation and to investigate their relationship with the progression of the disease and prognosis. Methods: The changes of T cell subsets in 12 patients with CMV infection complicated with ARDS after renal transplantation were detected. The AR, CD4, CD8 + T cell count And the ratio, taking 2 months after surgery without acute rejection and infection results as pre-infection control. Results: In 12 patients, 7 cases survived and 5 died. The counts and their ratios of CD4 + and CD8 + T cells in ARDS were significantly lower than those before infection. As the course of disease progressed, the counts of CD4 + and CD8 + Day, 14 days and improved treatment with immunosuppressive agents before rising, and were significantly higher than when ARDS, CD4 / CD8 ratio also increased, the treatment 14 days was significantly higher than the ratio of ARDS occurred. The CD4 + and CD8 + T cell counts in the death group showed a decreasing trend. The counts of CD4 + T cells in the 7th day and the 14th day of treatment were significantly lower than those in the surviving group, and the ratio of CD4 + / CD8 + remained low. CONCLUSION: The changes of CD4 +, CD8 + count and its ratio in patients with CMV infection and ARDS after renal transplantation have certain correlation with the severity and prognosis of disease, which can be used as a predictor of disease progression and clinical outcome. The above indicators that improve the condition, the prognosis is good, and the above indicators continue to decline or remain at a very low level is extremely low immunity, critically ill, prognosis