A Correlative Study Of The TLC,CMV-DNA Value,CD14~+/HLA-DR And TNF-? In Early Postoprative Kidney Transplant Recipients With The Pulmonary Infection

Objective The study aimed to explore peripheral blood Total Lymphocyte Count(TLC),the changes of serum CMV-DNA level,CD14~+/HLA-DR and change of expression rates of TNF-? early postoperative(within 6 months after operation)allogeneic kidney transplant recipients and determine their correlations to pulmonary infection,and analyze the distribution patterns of pulmonary infectious pathogens,thus provide reference for lowing the postoperative pulmonary infection incidence rate and improving prognostic of kidney transplant recipients.Methods:92 allogeneic kidney transplant recipients treated in hospital from 1 January 2012 to 1 March 2016 were enrolled in this research.All subjects were divided into the infection group(n=16)and the non-infection group(n=76)according to their pulmonary infection occurrences within 6 months after operation.The two groups were monitored at different points during the operation and in 6 months after operation.The peripheral blood TLC of the subjects was determined by blood cell analyzer and the load of CMV-DNA in peripheral blood was detected by FQ-PCR;the flow cytometry and ELISA were employed to analyze the expression rate of CD14~+/HLA-DR and measure the TNF-? level respectively.The pathogenic bacteria distribution and imaging examination of infected postoperative patients were also analyzed.Results:?There was no significant difference in TLC between the two groups prior to transplantation(Z=-1.340,P=0.180);the TLC of the infection group was lower than that of the non-infection group at the 8th,9th,10th,11th,12th and 16th week after operation,the difference is statistically significant with P value<0.05;?The CMV-DNA loads of both groups within 6 weeks after operation were lower than 1000 copies/ml,and the CMV-DNA load of the infection group saw a gradual rise from the 6th week and reached its highest level at the 11th week then declined,but the CMV-DNA load of the non-infection group never experienced obvious fluctuations through the monitoring process and remained at a low level.The CMV-DNA load of the infection group was higher than that of the non-infection group from the 6th week to the 20th week,and the difference is statistically significant with P value<0.05 at the 7th,8th,9th,10th,11th,12th and 16th week;?There was no significant difference in the expression rate of CD 14+/HLA-DR between the two groups prior to transplantation(Z=-1.685,P=0.092);When the infection occurred,the expression rate of CD 14+/HLA-DR of the infection group dropped fast and was significantly lower than the levels of the non-infection group at the same time(P<0.05);?The post-operation levels of TNF-a of the infection group were higher than the pre-operative value in the first 4 weeks,the results show statistically significant with P value<0.05,and the values rise firstly then fall in the first 4 weeks and rise again at the 7 th week.The TNF-a levels of the infection group subjects was higher than that of the non-infection group at the 2th,7th,8th,9th,10th,11th 12th and 16th week,the results show statistically significant with P value<0.05;?Of the 16 kidney transplant subjects,pathogens were detected in 13 cases,and not in the remaining 3 cases.In 13 cases of mixed bacteria infection.a total of 18 strains of bacteria were cultured,mainly G bacteria;?Chest CT imaging examination showed exudative lesions in the 16 kidney transplant subjects.Conclusion:When the total lymohocyte count and CD14~+/HLA-DR falling,CMV-DNA and TNF-? rising within 6 months after kidney transplantation the incidence of pulmonary infection may increase,which provide a reference for early diagnosis of pulmonary infection after kidney transplantation.