七例肝移植围手术期隐球菌感染的诊治  

Diagnosis and treatment ofperioperative cryptococcal infection during liver transplantation

作　　者：钱永兵 施永恒[2] 申川 韩龙志[1] 邓羽霄[3] 陈小松[1] 张建军[1] 夏强[1] Qian Yongbing;Shi Yongheng;Shen Chuan;Han Longzhi;Deng Yuxiao;Chen Xiaosong;Zhang Jianjun;Xia Qiang(Department of Liver Surgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;Department of Pathology,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;Critical Care Medicine,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院肝脏外科,200127 [2]上海交通大学医学院附属仁济医院病理科,200127 [3]上海交通大学医学院附属仁济医院重症医学科,200127

出　　处：《中华器官移植杂志》2019年第12期743-748,共6页Chinese Journal of Organ Transplantation

基　　金：上海市卫计委重中之重临床医学中心(2017ZZ01018);上海市申康三年行动计划(16CR1003A)。

摘　　要：目的总结肝移植围手术期隐球菌感染的临床特征、诊治方法及预后。方法收集2017年6月至2018年12月在上海交通大学医学院附属仁济医院行肝移植受者,分析该时期内7例隐球菌感染受者的原发病、手术资料、感染部位及范围、免疫抑制方案、治疗方案及预后等资料。结果肝移植后隐球菌感染发生率为1.2%(7/593),其中男/女为4/3,年龄为48±13岁,术前终末期肝病模型(MELD)评分为(8~41)分。术后隐球菌感染的时间为1~421 d;早期感染常合并细菌感染,患者可表现为发热、咳嗽、头痛、呼吸困难等,结合隐球菌抗原试验、影像学及活检等诊断。初期均给予氟康唑或联合氟胞嘧啶滴注,总疗程为4~8个月;同期降低免疫抑制强度;4例受者治愈,2例维持治疗中,1例术后2个月死亡。结论在肝移植受者围手术期隐球菌感染时,推荐选择恰当的抗隐球菌治疗和降低免疫抑制强度。Objective To summarize the clinical features,diagnosis,treatment and prognosis of perioperative cryptococcal infection during liver transplantation(LT).Methods From June 2017 to December 2018,7 patients with cryptococcal infection were recruited.The etiology of disease,surgical data,site/extent of infection,immunosuppressive regimen,therapeutic strategy and prognosis were analyzed.Results The incidence of cryptococcal infection after LT was 1.2%(7/593).There were 4 males and 3 females with an average age of(48±13)years and a preoperative MELD score of 8~41.Postoperative cryptococcal infection occurred from 1 to 421 days.Early stage cryptococcal infection was frequently complicated with bacterial infection.The predominant symptoms included fever,cough,headache and dyspnea.And a definite diagnosis was based upon cryptococcal antigen test,imaging and biopsy.Seven patients initially received fluconazole and/or fluorocytosine for a total period of 4~8 months while the intensity of immunosuppression waned.Four patients were cured,2 patients stayed on a maintenance therapy and 1 death occurred at 2 months after LT.Conclusions For perioperative cryptococcosis in LT recipients,appropriate anti-cryptococcal therapy and tapering of immunosuppression are recommended.

关 键 词：肝移植 隐球菌病 氟康唑 氟胞嘧啶 

分 类 号：R657[医药卫生—外科学]