肾移植术后新型冠状病毒肺炎二例诊疗体会  

Diagnosis and treatment of novelcoronavirus pneumonia after kidney transplant: a report of 2 cases

作　　者：马晓旭[1] 臧素华[2] 楚伟丽 许爱国[1] 姚孟英[1] 蒋冬梅 李会玲[1] 张庆宪[1] 邢丽华[1] Ma Xiaoxu;Zang Suhua;Chu Weili;Xu Aiguo;Yao Mengying;Jiang Dongmei;Li Huiling;Zhang Qingxian;Xing Lihua(Department of Respiratory&Critical Care Medicine,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450000,China;Department of Cardiology,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450000,China;Department of Respiratory Medicine,Municipal Hospital,Shangqiu 476000,China)

机构地区：[1]郑州大学第一附属医院呼吸暨危重症医学科,450000 [2]郑州大学第一附属医院心外科,450000 [3]商丘市立医院呼吸病区,476000

出　　处：《中华器官移植杂志》2020年第4期207-211,共5页Chinese Journal of Organ Transplantation

基　　金：河南省医学科技攻关计划省部共建项目(SB201901036)。

摘　　要：目的:分析肾移植术后合并新型冠状病毒感染后的临床特征及诊疗特点。方法:回顾郑州大学第一附属医院2020年2月收治的2例肾移植术后合并新型冠状病毒肺炎(COVID-19)的诊治经过,搜集病史、实验室及影像学检查、治疗方案及转归。2例受者均为中年男性,分别在移植后11个月和12个月发病,均以中低热起病,伴咳嗽、乏力,胸部CT提示双肺靠近胸膜磨玻璃及斑片状渗出影,早期合并了不同程度肾功能及心功能不全。结果:例1治疗过程中免疫抑制剂减量应用,并增大了糖皮质激素用量;例2免疫抑制剂未减量,早期因肾功能不全和高钾血症透析3次。2例均给予吸氧、洛匹那韦/利托那韦、阿比多尔口服及干扰素α-2b抗病毒治疗、抗感染治疗后临床治愈。结论:肾移植术后COVID-19受者的临床表现及诊断与其他人群无明显差异,但早期出现了肾功能和心功能异常。肾移植受者合并重型COVID-19治疗过程中免疫抑制剂如何调整需要进一步探讨。Objective To explore the clinical features and managements of novel coronavirus(2019-nCoV)infection after kidney transplantation.Methods The authors reviewed medical history,laboratory values,imaging studies,treatment options and clinical outcomes of two confirmed hospitalized cases of COVID-19 after kidney transplant in February 2020.Both cases were middle-aged males and confirmed as COVID-19 at 11 or 12 months after transplantation.They both presented initially with moderate-to-low fever,cough and fatigue.Chest computed tomography(CT)hinted at multiple peripheral patchy ground glass opacities or patchy exudation and in bilateral multiple lobular and subsegmental with obscure boundary.Both had varying degrees of renal function and cardiac insufficiency.Results In case 1,the dose of immunosuppressants was tapered while a higher dose of glucocorticoids was prescribed during treatment.In case 2,the dose of immunosuppressants was not tapered and continuous renal replacement therapy(CRRT)performed thrice in the early disease course due to renal insufficiency and hyperkalemia.Both cases received oxygen inhalation,lopinavir/ritonavir,oral abidor and interferonα-2b antiviral therapy,antibiotics treatment.Both cases were cured.Conclusions The clinical manifestations and diagnosis of COVID-19 patients after kidney transplantation are not significantly different from those of other people.However,early renal function and heart function abnormalities occur.How to adjust the immunosuppressant in the treatment course of severe COVID-19 after renal transplantation should be further explored.

关 键 词：肾移植 新型冠状病毒肺炎 免疫抑制剂 

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