肾移植术后军团菌肺炎  

Legionella pneumonia after renal transplantation

作　　者：方自林[1] 张钊[1] 姜永金[1] 林江涛[2] 薛福林[2] 鲍镇美[1] 

机构地区：[1]中日友好医院泌尿外科,北京100029 [2]中日友好医院呼吸内科

出　　处：《医学研究通讯》2002年第5期38-40,共3页Bulletin of Medical Research

摘　　要：报道了一例同种异体尸体肾移植患者术后发生军团菌肺炎,并就其发生的病因学、流行病学、临床表现、诊断及治疗进行了讨论,表明早期诊断、特异性治疗和支持疗法以及抗感染和免疫抑制的合理调整是治疗的关键。研究认为,肾移植患者应避免易感环境因素,一旦诊断明确,应给予口服红霉素和利福平;如果在急性排异的同时发生了致命的感染,应给予强力抗生素,必要时停用免疫抑制剂,即使是可能导致移植肾的丧失。In January 1991, a 27 - year - old male was admitted to our hospital with chronical renal failure. Physical examination showed the patient had anemia and uremia. After hemodialysis for halfayear, a cadveric allograft renal transplantation was done with a routine trigemieal immunosuppression.Graft function became nonnal within two weeks.Forty days after the operation, the patient comlained of moderate fever, chest pain and bloody sputum, serum indirect fluorescent antibody assay showed Lp6 antibody liter as 1: 160, and Lp6 antigen had been detected in transbroncheal aspiration specimens. Chest radiography showed patchy in filtration and cavity in both lungs. All the evidences supported the diagnosis of le-gionella pneumonia.The dosage for Erythromycin was administered 1 ~ 2g every day followed by leucomycin 0.8g every day for three weeks.Two weeks later, the patient died of massive hemoptysis. We concluded that the poor environmental condition must be voided, and once the diagnosis had been maed, erythromycin or combination with oral rifampia should be given. If acute rejection occur with life - threatening infection, we should give potential antibiotic therapy and discontinue the immunosuppression, even this could lead to the extirpation of renal graft.

关 键 词：肾移植 军团菌肺炎 抗生素 免疫抑制 病因 临床表现 诊断 

分 类 号：R699.2[医药卫生—泌尿科学] R563.1[医药卫生—外科学]