肾移植术后侵袭性肺部真菌感染的诊治  

Invasive Pulmonary Fungal Infection in Kidney Transplant Recipients:Its Diagnosis and Treatment

作　　者：刘德忠[1] 钱叶勇[1] 石炳毅[1] 柏宏伟[1] 常京元[1] 刘奎利[1] 蔡明[1] 

机构地区：[1]解放军总医院第二附属医院全军器官移植中心,北京100091

出　　处：《中华医院感染学杂志》2009年第9期1060-1063,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨肾移植术后并发侵袭性肺部真菌感染(IPFI)的诊断和治疗措施。方法回顾性分析25例肾移植术后侵袭性肺部真菌感染患者的临床资料。结果肾移植术后侵袭性肺部真菌感染的发生时间主要集中在术后3个月内;25例患者中,痰真菌培养阴性5例,阳性20例,其中白色假丝酵母菌感染9例,平滑假丝酵母菌、克柔假丝酵母菌感染各2例,热带假丝酵母菌感染1例,曲霉菌属感染5例,近平滑假丝酵母菌及克柔假丝酵母菌混合感染1例;单独应用氟康唑治愈12例,单独应用伏立康唑治愈3例,先用氟康唑、改用伏立康唑治愈4例,单一应用伊曲康唑治愈2例,伏立康唑联合及序贯卡泊芬净治愈2例,死亡2例;治疗过程中减量或停用免疫抑制剂5例。结论肾移植术后IPFI的诊断主要依靠影像学及病原学检查,对拟诊病例,宜尽早开始经验性治疗,临床诊断病例及时抢先治疗,以能早期控制病情进展,提高治愈率。OBJECTIVE To diagnose and treat the invasive pulmonary fungal infection （IPFI） in kidney transplant recipients. METHODS The clinical data of 25 cases of IPFI after renal transplantation were retrospectively analyzed. RESULTS The onset of IPFI of most cases was within 3 months after transplantation. Twenty cases were with fungi positive in sputum culture. Among them, 9 cases were infected with Candida albicans, 2 with C. glabrata, 2 with C. krusei, 1 with C. tropicalis, 5 with Aspergillus and 1 case was with mixed infection of C. parapsilosis and C. krusei. Twelve cases were cured with fluconazole, 7 cases with voriconazole and 2 cases with itraconazole. Two cases were cured with the combining and sequencing use of voriconazole and caspofungin. Two cases died. Immunosupressant therapy was ceased or decreased in 5 cases within the treating process. CONCLUSIONS Only by early diagnosis through chest imaging and/or fungal etiology, giving empirical and pre- emptive therapy in IPFI following renal transplantation, can we decrease the risk of death.

关 键 词：肾移植 肺部 真菌感染 诊断 治疗 

分 类 号：R379[医药卫生—病原生物学]