Florescu Diana F, Hermsen Elizabeth D, Kwon Joong Y, Gumeel Dalal, Grant Wendy J, Mercer David F, Kalil Andre C
Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5400, USA.
Pediatr Transplant. 2011 Nov;15(7):718-21. doi: 10.1111/j.1399-3046.2011.01556.x. Epub 2011 Aug 23.
No treatment for NVE is available. Immunocompromised patients with NVE treated with OHIG (12 cases) were retrospectively identified and matched 1:1 by age and gender with immunocompromised patients with NVE not treated with OHIG (12 controls). Chi-squared test, t-test, bivariate conditional linear regression analyses, and Kaplan-Meier curve were performed. A total of 58.3% patients were small bowel transplant (SBT) recipients. Although not statistically significant, cases compared with controls were more likely to have had induction therapy (p = 0.25, OR = 65.3), higher peak tacrolimus levels (p = 0.43, OR = 1.04), SBT (p = 0.30, OR = 65.3), prior NVE (p = 0.42, OR = 2.0), TPN support (p = 0.42 OR = 2.0), and decrease in immunosuppression (p = 0.14, OR = 5.0). Treatment with OHIG favored resolution of diarrhea (p = 0.078, OR = 65.3) and decreased stool output seven days after treatment compared with controls (mean difference 11.95 mL/kg/day, p = 0.09). OHIG did not impact total time to resolution of diarrhea (mean 12.08 vs. 11.91 days; p = 0.63), length of hospital stay (p = 0.31, OR = 1.05), or cost of hospitalization (p = 0.32, OR = 1.0). We show a potential role of OHIG treatment for NVE. Resolution of diarrhea and decreased stool output were observed at seven days; no benefit was found for length of hospital stay or hospital cost.
目前尚无针对坏死性小肠结肠炎（NVE）的治疗方法。对12例接受OHIG治疗的免疫功能低下的NVE患者进行回顾性分析，并按年龄和性别1:1匹配12例未接受OHIG治疗的免疫功能低下的NVE患者作为对照。进行卡方检验、t检验、双变量条件线性回归分析和Kaplan-Meier曲线分析。共有58.3%的患者为小肠移植（SBT）受者。与对照组相比，病例组虽无统计学差异，但更有可能接受过诱导治疗（p = 0.25，OR = 65.3）、他克莫司峰值水平更高（p = 0.43，OR = 1.04）、接受SBT（p = 0.30，OR = 65.3）、既往有NVE（p = 0.42，OR = 2.0）、接受全胃肠外营养（TPN）支持（p = 0.42，OR = 2.0）以及免疫抑制降低（p = 0.14，OR = 5.0）。与对照组相比，OHIG治疗有利于腹泻的缓解（p = 0.078，OR = 65.3），且治疗7天后粪便排出量减少（平均差异11.95 mL/kg/天，p = 0.09）。OHIG对腹泻缓解的总时间（平均12.08天对11.91天；p = 0.63）、住院时间（p = 0.31，OR = 1.05）或住院费用（p = 0.32，OR = 1.0）均无影响。我们显示了OHIG治疗NVE的潜在作用。治疗7天时观察到腹泻缓解且粪便排出量减少；但未发现对住院时间或住院费用有获益。
