肾移植术后间质性肺炎的诊断及治疗的经验总结  

Diagnosis,treatment and a single center experience of interstitial pneumonia after renal transplantation

作　　者：宋萍[1] 翟秀宇[1] 王淮林 王钢[1] 王远涛[1] 周洪澜[1] 胡钰[2] SONG Ping;ZHAI Xiu-yu;WANG Huai-lin(2nd Department of Urology,The First Hospital of Jilin University,Chang-chun 130021,China)

机构地区：[1]吉林大学第一医院泌尿外二科,吉林长春130021 [2]吉林大学中日联谊医院病理科,吉林长春130033

出　　处：《中国实验诊断学》2018年第8期1320-1323,共4页Chinese Journal of Laboratory Diagnosis

基　　金：国家自然科学基金面上项目(81671574;81470975)

摘　　要：目的探讨肾移植术后间质性肺炎的临床诊治策略。方法回顾性分析我院2008年1月至2017年6月收治的166例肾移植术后早期间质性肺炎患者的临床资料,比较间质性肺炎发病率及其与移植类型、诱导治疗的关系,分析其发病原因及诊疗过程。结果我院肾移植术后间质性肺炎呈逐年下降趋势,且易发生于术后2-12个月。166例患者大多以发热、胸闷、呼吸困难为主要症状入院,影像学表现为肺部间质性改变。病原学诊断较为困难,细菌感染6.0%,病毒感染16.3%,肺炎支原体感染4.2%,真菌感染7.8%,但仍有65.7%的患者未查出病因。住院时间7-38天,平均16.5天。3.0%出现呼吸功能衰竭,死亡3例,占1.8%,余均临床治愈。1.8%患者治疗期间出现移植肾排斥反应,经抗排斥治疗后肾功能恢复正常水平。亲属肾移植350例,间质肺发病率为7.7%,其他类型肾移植1245例,间质肺发病率11.2%,亲属肾移植间质肺发病率较其他类型肾移植术后间质性肺炎发病率低。诱导治疗733例,间质肺发病率10.2%,未诱导治疗862例,间质肺发病率10.6%,抗体诱导治疗与肾移植术后间质性肺炎的发生率无明显相关。结论肾移植术后间质性肺炎诊断以症状及影像学改变为主,病原学诊断较困难。治疗上应给予停用或减量免疫抑制剂,抗细菌、抗病毒、抗真菌、应用激素及预防卡氏肺孢子菌的综合治疗方案,另外对症支持治疗必不可少。亲属肾移植发病率较其他类型肾移植术后间质性肺炎发病率低,抗体诱导治疗与肾移植术后间质性肺炎的发生无明显相关。Objective To investigate clinical diagnosis and treatment strategies of renal transplantation of interstitial pneumonia.Methods A retrospective analysis of the clinical data of 166 cases of renal transplantation were treated in our hospital early with interstitial pneumonia from January 2008 to June 2017,to compare of interstitial pneumonia morbidity and type of transplantation,the relationship between the treatment of induction,analysis of the causes and treatment process.Results Interstitial pneumonia after renal transplantation in our hospital decreased year by year,and was prone to occur in 2-12 months after operation.Fever,chest tightness,dyspnea was the main symptom in hospital,the imaging manifestations of pulmonary interstitial changes.Etiological diagnosis is difficult,6% bacterial infection,virus infection 16.3%,4.2% Mycoplasma pneumoniae infection,fungal infection 7.8%,while there are still 65.7% of the patients did not identify the cause.The hospitalization time was 7-38 days,average 16.5 days.3%respiratory failure occurred,3 cases died accounting for 1.8%,the others were cure.Appearance of renal transplantation patients during treatment 1.8% rejection,normal renal function recovery after anti rejection treatment.In relative kidney transplantation,interstitial lung disease incidence rate is 7.7%,other types of kidney transplantation in 1245 cases,interstitial lung disease incidence rate 11.2%,relatives of renal transplant interstitial pulmonary disease incidence rate than other types of renal transplantation between the incidence of pneumonia rate is low.Induction therapy in 733 cases,interstitial lung disease incidence rate 10.2%,862 cases of no induction therapy,interstitial lung disease incidence rate 10.6%,antibody induction therapy after renal transplantation and interstitial pneumonia rate showed no significant difference.Conclusion Diagnosis of interstitial pneumonia after renal transplantation are symptoms and imaging changes,etiological diagnosis is difficult.Treatment should be given to disa

关 键 词：肾移植术后 间质性肺炎 诊断及治疗 免疫抑制方案 

分 类 号：R563.13[医药卫生—呼吸系统]