肺移植术后副流感病毒性肺炎一例及文献复习  

Parainfluenza virus pneumonia after lung transplantation :a case report and literature review

作　　者：孔育姗 伍造端 田科[1] 谷刚[1] 李丽娟[2] Kong Yushan;Wu Zaoduan;Tian Ke;Gu Gang;Li Lijuan(Affiliated Nanhua Hospital,Nanhua University,Hengyang 421002,China;Department of Respiratory & Critical Diseases,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]南华大学附属南华医院,衡阳421002 [2]中日友好医院呼吸与危重症学科,北京100029

出　　处：《中华器官移植杂志》2019年第7期423-427,共5页Chinese Journal of Organ Transplantation

摘　　要：目的探讨肺移植术后继发副流感病毒性肺炎的临床特点、诊治及预后.方法回顾性分析1例肺移植术后合并副流感病毒性肺炎病例的诊治经过,并总结国内外现有相关病例报道及文献复习.结果受者因慢性阻塞性肺病、肺大疱、呼吸衰竭接受序贯式双肺移植术.术后常规抗排斥治疗.术后14个月,受者因咳嗽、气促1个月余入院;术后15个月连续3次查痰细菌、真菌涂片及培养均显示副流感病毒核酸检测阳性.明确诊断为肺移植术后副流感病毒性肺炎,给予利巴韦林抗病毒治疗,以及气管插管、有创呼吸机辅助通气,后给予亚胺培南加多西环素联合抗感染治疗,更昔洛韦抗病毒治疗,反复行支气管镜吸痰灌洗治疗,受者病情无改善,并于术后16个月因呼吸衰竭、感染性休克死亡.结论肺移植术后副流感病毒感染重在预防,PCR法是快速检测病毒感染的最主要方法,但尚无确定的治疗副流感病毒感染的方法,特异性的副流感免疫球蛋白和DAS181雾化吸入可能是将来治疗肺移植受者副流感病毒感染的一种选择.Objective To explore the clinical characteristics ,diagnosis ,treatment and prognosis of parainfluenza virus (PIV) pneumonia after lung transplantation .Methods One case of PIV pneumonia after lung transplantation was retrospectively analyzed . The relevant domestic and foreign cases and literature review were summarized .Results The recipient underwent sequential bilateral lung transplantation for chronic obstructive pulmonary disease ,bullae and respiratory failure .Donor lung was sourced from donation after cardiac death .Routine anti-rejection therapy was prescribed postoperatively .At 14 months ,cough and shortness of breath lead to hospitalization for over 1 month .At 15 months ,sputum/fungal smear and culture showed that nucleic acid of PIV was positive . The definite diagnosis was PIV pneumonia after lung transplantation .After ribavirin antiviral therapy ,tracheal intubation and invasive ventilation ,followed by imipenem plus doxycycline plus anti-infective therapy ,ganciclovir antiviral therapy ,repeated bronchoscopic sputum aspiration and lavage treatment ,the patient's condition deteriorated and died from breathing failure and septic shock at 16 months .Conclusions Preventing PIV infection after lung transplantation is of vital importance .PCR is essential for a rapid detection of virus infection .However ,there is no curative treatment of PIV infection .Specific parainfluenza immunoglobulin and DAS 181 aerosol inhalation may be applied for future treatment of PIV infection in lung transplant recipients .

关 键 词：肺移植 副流感病毒 肺炎 

分 类 号：R563[医药卫生—呼吸系统] R65[医药卫生—内科学]