肾移植术后侵袭性肺曲霉感染15例临床诊治  

Diagnosis and treatment of invasive pulmonary aspergillosis after renal transplantation

作　　者：刘仰东[1] 张爱民[1] 李香铁[1] 郝俊文[1] 闵勇正[1] 宋华[1] 张立卿[1] 

机构地区：[1]济南军区总医院泌尿外科,250031

出　　处：《中华移植杂志（电子版）》2013年第4期18-20,共3页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的探讨肾移植受者术后侵袭性肺曲霉(IPA)感染的诊治。方法回顾性分析济南军区总医院泌尿外科2008年7月至2013年5月肾移植术后15例IPA感染受者的临床资料。结果 15例受者均为首次肾移植,均为肾移植术后半年内发生IPA感染,最早于术后16 d发现。经半乳甘露聚糖试验(GM试验)检出IPA 9例,肺部CT检查检出4例,血培养检出3例,痰培养检出5例。9例合并CMV或细菌感染,2例合并假丝酵母菌属感染,4例为单纯性IPA感染。13例IPA感染受者给予伏立康唑注射液治疗(3例为确诊病例,10例为临床诊断病例),其中2例合并或序贯给予米卡芬净;另2例临床诊断病例给予伊曲康唑注射液治疗。共有9例受者治愈,6例死亡。结论 GM试验、肺部CT检查等对肾移植术后IPA感染具有一定的诊断价值,结合临床表现,能够较早诊断IPA感染,有助于及时进行早期治疗,提高患者生存率。Objective To observe and explore the diagnosis and treatment of invasive pulmonary aspergillosis （ IPA） after renal transplantation .Method Fifteen patients in Jinan Military General Hospital diagnosed with IPA after renal transplantation were retrospectively analyzed .Results Among 15 patients, 9 were diagnosed by galactomannan test （GM test）, 4 by CT, 3 by blood culture, and 5 by sputum samples.In those patients, 9 were supervened by cytomegalovirus or bacterial infection, 2 were done by Candida infection , and 4 underwent exclusively IPA.After diagnosed, intravenous voriconazole was given immediately for 13 patients, of whom 2 were given micafungin concurrently or sequentially .Itraconazole injection was given for 2 patients.In this study, 9 patients were cured, and 6 died.Conclusion Both GM test and CT play important roles in the diagnosis of IPA after renal transplantation .Early diagnosis and treatment for IPA after renal transplantation are very important to improve the survival rate of the patients .

关 键 词：肾移植 侵袭性肺曲霉 感染 

分 类 号：R699.2[医药卫生—泌尿科学]