肾移植并发肺孢子菌肺炎82例临床特征分析  

Clinical features of 82 renal transplant recipients complicated with Pneumocystis carinii pneumonia

作　　者：何绍平 叶远馨[1] 王旻晋[1] 钟慧钰 巫丽娟[1] 应斌武[1] HE Shaoping;YE Yuanxin;WANG Minjin;ZHONG Huiyu;WU Lijuan;YING Binwu(Department of Laboratory Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院实验医学科,成都610041

出　　处：《华西医学》2021年第3期374-378,共5页West China Medical Journal

基　　金：中国科学技术部国家科技重大专项(2018ZX10715003)。

摘　　要：目的分析肾移植受者肺孢子菌感染的临床特征及诊疗措施,为预防和诊疗提供依据。方法回顾性分析四川大学华西医院2016年1月—2019年12月收治的82例肾移植术后并发PCP患者的临床资料。结果肾移植合并PCP患者发病中位时间为3.50(2.78,8.27)个月,6个月内发病57例(69.51%),临床表现以发热、咳嗽和气紧为主;胸部CT主要表现为磨玻璃改变和斑片状阴影;实验室炎性指标以淋巴细胞降低、超敏C反应蛋白和(1,3)-β-D-葡聚糖升高为主;82例(100%)患者均合并有细菌、病毒或其他真菌感染;诊断、治疗和住院中位时间分别为6.00(3.00,8.25)d、20.00(12.75,32.25)d、26.50(20.75,39.00)d;经过治疗,66例(80.49%)患者治疗有效,14例(17.07%)治疗失败,2例(2.44%)死亡。结论肾移植受者PCP发生时间主要在6个月内,常合并其他感染,应结合临床表现、实验室及影像学检查早期诊断及尽早进行个体化的治疗。Objective To analyze the clinical characteristics and measures of diagnosis and treatment of renal transplant recipients complicated with Pneumocystis carinii pneumonia(PCP), in order to provide basis for prevention and treatment. Methods The clinical data of 82 renal transplant recipients complicated with PCP admitted to the West China Hospital of Sichuan University from January 2016 to December 2019 were retrospectively analyzed. Results The median time from transplantation to diagnosis of PCP was 3.50(2.78, 8.27) months, and 57 cases(69.51%) were occurred within 6 months. The main clinical manifestations were fever, cough and shortness of breath, and chest CT scan mainly showed ground-glass opacity and patchy shadows. The laboratory examination showed a decrease of lymphocyte,increased high-sensitivity C-reactive protein and(1-3)-beta-D glucan. All 82 patients(100%) were complicated with bacterial, virus infections or other fungal infections. The median time of diagnosis, treatment and hospital stay was 6.00(3.00, 8.25) d, 20.00(12.75, 32.25) d, 26.50(20.75, 39.00) d, respectively. Sixty-six cases(80.49%) were discharged with effective treatment, yet 14 cases(17.07%) suffered a failed treatment and 2 cases(2.44%) died. Conclusions The incidence of PCP infection was highest within the first 6 months after renal transplantation, and multiple infections tend to easily occured. Early diagnosis should be made in combined with clinical manifestations, laboratory and imaging examinations, and individualized treatment should be taken early.

关 键 词：肾移植 肺孢子菌肺炎 临床特征 诊断 治疗 

分 类 号：R699.2[医药卫生—泌尿科学] R446.5[医药卫生—外科学]