重症肾脏疾病患者并发肺部真菌感染的临床特征  

Analysis of pulmonary fungus infection in patients with severe kidney diseases

作　　者：何群鹏[1] 谢红浪[1] 许书添[1] 桂兰兰[1] 柳晶[1] 杨柳[1] 胡伟新[1] 刘志红[1] 

机构地区：[1]南京军区南京总医院全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2012年第5期408-412,434,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家科技支撑计划课题(2011BAI10B04)

摘　　要：目的:分析并探讨重症肾脏疾病患者并发肺部真菌感染的临床特征及易感因素。方法:回顾性分析25例并发肺部真菌感染的重症肾脏病患者的基本临床资料,所有患者均经病原学及影像学依据确诊肺部真菌感染,根据病原学及药敏结果给予抗真菌治疗。结果:本组患者中男13例,女12例,平均52.1±16.5岁(21～76岁);其中狼疮性肾炎6例,抗中性粒细胞胞质抗体相关性系统性血管炎5例,肾移植术后患者3例,原发性肾病综合征5例,慢性肾功能不全3例,糖尿病肾病、多发性骨髓瘤和流行性出血热各1例。最常见的感染病原是白色假丝酵母菌(13例,52%),其次是曲霉菌(8例,32%),另有热带假丝酵母菌2例(8%),光滑假丝酵母菌和新型隐球菌各1例(4%)。19例(76%)患者在感染前使用免疫抑制治疗。易感因素包括高龄,应用免疫抑制剂,贫血,低蛋白血症,免疫功能异常及合并糖尿病等。结论:重症肾脏疾病行免疫抑制治疗患者易并发肺部真菌感染,其中白色假丝酵母菌最常见,控制易感因素、早期诊断、及时治疗是预防及治疗真菌感染的有效途径。Objective： To investigate the incidence, clinical manifestation and risk factors of pulmonary fungus infection in hospitalized patients with chronic kidney disease （CKD）. Methodology： Twenty five patients, who acquired pulmonary fungus infection with CKD in our centre during from Nov 2009 to Nov 2011, were enrolled this study. Their clinical manifestation and risk factors of pulmonary fungus infection were retrospectively investigated. All patients had pathogen and image examination, and accepted antifungal drugs. Results： 25 cases （2.9%） of pulmonary fungus infection were found among 874 in renal ICU. They were 13 males and 12 females with the age ranged from 21 to 76 years old. The patients with lupus nephritis and systemic vasculitis were easy to get infection. Among them, 13 cases were infected with Candida albicans, 8 with Aspergillus, 2 with Candida tropicalis, one with Candida glabirate and one with Crypococcus. 19 cases of them （76%） were taken immunosuppressant before infection. The predisposing factors included advanced age, immunosuppressant, anemia, hypoproteinemia, immune deficiency, diabetes and use respirator. Conclusion： The patients who received immunosuppressive drugs may predispose to pulmonary fungus infection, and the most common fungus was Candida albicans. The prognosis will be better if the predisposing factors be controlled and the diagnosis and treatment is in time.

关 键 词：重症肾脏疾病 肺部真菌感染 危险因素 临床特点 

分 类 号：R519[医药卫生—内科学]