The Clinical Characters Of Pneumonitis In Patients With Renal Transplantation And Significance Of Serum Procalcitonin

Infection is the main complication after organ transplantation. The respiratory system is involved most commonly in patients with renal transplantation. The hypofunction of immunity system make it easier for patients to get the community or hospital acquired infections, including the infections cause by the conditional pathogenic bacteria. Such infections of lungs have the characters of non-typical clinical features, hard-identified pathogen, severe patients condition, higher fatality. If the patients could not be diagnosed and treated in time, the prognosis is very severe. Procalcitonin (PCT) is non-hormone-activeness propetide of calcitonin. The serum level of procalciton increased significantly in patients with SIRS, MODS, pyemia,septic shock et al, implied the possibility of indicating the severe infections. Recent research showed that PCR had high sensitivity and specificity in diagnosis of bacterial pathogen. 70% pneumonia in patients with renal transplantation had been caused by bacteria or non-bacteria pathogen. The identification of bacterial or non-bacterial pneumonia is helpful in use of the antibiotics in clinical. Does the serum level of PCT in patients with renal transplantation distinguish the bacterial pneumonia is not clear yet.ObjectiveTo study the clinical characters of pneumonia patients with renal transplantation, improve the ability of early diagnosis and treatment; To study the role of serum PCT in diagnosis and distinguishing the bacterial or non-bacterial pneumonia in patients with renal transplantation, guide the use of antibiotics in clinic, improve survival of human/kidney.MethodFrom June 2004 to December 2005, 58 pneumonia patients with renal transplantation were selected. The clinical characters, image results, blood gas analysis, pathogen results were recorded. The count of WBC, the proportion of neutrophile granulocyte and serum PCT were tested in 24 hours after admission. The ROC curves of temperature, count of WBC, the proportion of neutrophile granulocyte,serum PCT were calculated and their sensitivities, specificities, positive predictive values(PPV), negative predictive values(NPV) and diagnostic rates were compared.ResultsIn all 58 patients, 38 had the symptoms of chest distress and tachypnea; 52 patients had diffuse inflammation in bi-lateral lungs; 68.9% patients had the pathogen of virus or bacteria; 53 patients had hypoxemia and 12 had typeⅡrespiratory failure; 12 patients accepted nasal catheter oxygen inhalation, 32 accepted BiPAP non-invasive ventilation, 14 accepted mechanical ventilation by incision of trachea or tracheal intubation.The ROC curves showed that T>38.5℃, WBC >10.41×109/L,the proportion of neutrophile granulocyte>82%,serum PCT≥0.5ng/ml could be used in diagnosis of bacterial pneumonia. And the serum PCT had the highest sensitivity and specificity. The patients of positive PCT were higher incident in bacteria infection, the patients of negative PCT were higher incident in non-bacteria infection, the level of PCT showing intimate relevance with bacteria or non-bacteria infection.ConclusionFever is a danger signal in pneumonia patients with renal transplantation, SaO2 monitoring is sensitive to early pulmonary infection early stage, HRCT of chest is important in diagnosis of pulmonary infection early stage. Serum PCT is useful diagnosis tool in identifying pathogen, serum PCT≥0.5ng/ml could be used in distinguishing bacteria pneumonia. And more the level of PCT, more the possibility of bacterial pneumonia. The serum PCT also can be used as an indication of antibiotic.