肾移植受者继发新型冠状病毒肺炎二例临床报告  

Two clinical cases of novel coronavirus pneumonia (COVID-19) in renal transplant recipients

作　　者：涂亚芳[1] 吴雄飞 刘锋[1] 王娟[1] 骆雨 蔡治涛 陈仁贵 廖雯靓 刘娜[1] 黄静[1] Tu Yafang;Wu Xiongfei;Liu Feng;Wang Juan;Luo Yu;Cai Zhitao;Chen Rengui;Liao Wenliang;Liu Na;Huang Jing(Center of Nephrology andDialysis,transplantation,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院肾病与透析移植中心,430060

出　　处：《中华器官移植杂志》2020年第3期144-147,共4页Chinese Journal of Organ Transplantation

摘　　要：目的:探讨肾移植受者继发新型冠状病毒感染的肺炎(COVID-19)临床特点、诊治和预后。方法:回顾性分析2例肾移植受者继发COVID-19的病例资料,从临床表现、血常规、炎症因子、细胞免疫、胸部CT、治疗效果方面,对比《新型冠状病毒肺炎诊疗方案(试行第五版)》。2例受者均以中低热起病,初期无咳嗽、乏力,血常规提示白细胞正常范围,淋巴细胞计数明显减少,C-反应蛋白增高,降钙素原稍偏高,细胞免疫极低,胸部CT提示双肺多发斑片状磨玻璃影。结果:起病1周后2例受者均病情进展明显,与已报道的普通人COVID-19发病过程及影像学改变高度相似。给予抗病毒、停免疫抑制剂、中小量激素维持、丙种球蛋白静脉滴注、呼吸支持、避免继发感染及对症支持治疗。目前2例受者病情均明显好转,肾功能稳定,其中1例已康复出院。结论:肾移植受者COVID-19临床表现与普通患者大体一致。虽无特异性的治疗COVID-19方法,但停用免疫抑制剂、中小剂量激素维持、积极恢复免疫力、及时给予呼吸支持是行之有效的。Objective To explore the clinical features,diagnosis and prognosis of renal transplant recipients with COVID-19.Methods The clinical data were retrospectively analyzed for 2 kidney transplant recipients with COVID-19.Based upon clinical manifestations,blood routine,inflammatory factors,cell immunity,chest computed tomography(CT)and therapeutic efficacies,the diagnosis and treatment of COVID-19 in kidney transplant recipients(Interim Edition V)were compared to that of ordinary COVID-19 patients.Both recipients had an onset of low/moderate fever.There was no initial symptom of cough or fatigue.Blood routine indicated a normal count of leukocytes,a marked lymphocytopenia,elevated C-reactive protein(CRP)and slightly higher procalcitonin(PCT).Cellular immunity was extremely low and chest CT showed multiple patchy ground-glass opacities in both lungs.Results After 1 week of onset,both patients had a marked disease progression.The pathogenesis and imaging changes were highly similar to those reported for ordinary COVID-19 patients.For preventing secondary infections,both received symptomatic supportive measures of antiviral agents,withdrawing immunosuppressants,tapering of hormone maintenance dose,intravenous drip of gamma globulin and respiratory supports.Currently the conditions of both patients obviously improved and renal function was stable.One case recovered and was discharged.Conclusions The clinical manifestations of COVID-19 in renal transplant recipients are generally consistent with that of ordinary COVID-19 patients.Although there is no established treatment for COVID-19,withdrawing immunosuppressants,maintaining small and medium doses of hormones,actively restoring immunity and providing respiratory supports in a timely manner are effective.

关 键 词：肾移植 新型冠状病毒肺炎 免疫抑制 

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