肺出血-肾炎综合征合并肺部感染一例并文献复习  

Goodpasture syndrome complicated with lung infection:a case report and literature review

作　　者：岑天天 张晓群 马红映[3] Cen Tiantian;Zhang Xiaoqun;Ma Hongying(Health Science Center,Ningbo University,Ningbo 315211,China;不详)

机构地区：[1]宁波大学医学部,宁波315211 [2]宁波大学附属第一医院肾内科,宁波315010 [3]宁波大学附属第一医院呼吸与危重症医学科,宁波315010

出　　处：《新医学》2023年第10期743-748,共6页Journal of New Medicine

基　　金：浙江省教育厅一般科研项目(Y202043918);宁波市自然科学基金(2021J242);宁波市社会公益研究项目(2021S163)。

摘　　要：目的 探讨肺出血-肾炎综合征合并肺部感染的临床特征及诊治要点。方法 回顾性分析一例肺出血-肾炎综合征合并肺部感染患者的临床资料,以“肺出血-肾炎综合征/Goodpasture综合征”和“感染”的中英文为检索词分别在PubMed、Embase、Web of Science、CNKI和万方数据知识服务平台检索国内外相关病例,检索时间截至2022年9月。总结肺出血-肾炎综合征合并肺部感染的临床表现及患者预后。结果 该例为51岁男性患者,因血清肌酐升高1月余、痰中带血10余日入院,患者咳黄绿色脓痰,双肺闻及湿啰音,肾脏穿刺活组织病理学检查示新月体型肾小球肾炎、抗肾小球基底膜IgG抗体弱阳性,胸部CT提示双肺多发炎症,肺泡灌洗液镜下可见组织细胞吞噬现象,痰真菌涂片和荧光染色、肺泡灌洗液培养、肺泡灌洗液宏基因组二代测序提示多种微生物感染,考虑肺出血-肾炎综合征合并肺部感染,先后予肾脏替代治疗、免疫抑制、抗感染等综合治疗,患者病情缓解后出院,但其后患者再因重症肺炎、脓毒症休克、呼吸衰竭入院并转ICU,最终死亡。检索到27例肺出血-肾炎综合征合并肺部感染,常见的肺部感染病原体有侵袭性肺曲霉、肺孢子虫、结核菌、巨细胞病毒等,确诊死亡病例13例,其中死于呼吸衰竭和(或)呼吸系统感染4例。结论 对于肺出血-肾炎综合征患者应警惕感染,尤其是严重的肺部感染。Objective To investigate the clinical characteristics,diagnosis and treatment of Goodpasture syndrome complicated with lung infection.Methods Clinical data of one case of Goodpasture syndrome complicated with pulmonary infection were retrospectively analyzed.Literature review was performed from PubMed,Embase,Web of Science,China National Knowledge Infrastructure(CNKI)and Wanfang Data Knowledge Service platform using“Goodpasture syndrome”and“infection”as search terms from the database inception date to September 2022.Clinical manifestations and prognosis of Goodpasture syndrome complicated with pulmonary infection were summarized.Results The 51-year-old male patient,was admitted to our hospital due to elevated serum creatinine level for more than one month and blood in sputum for over 10 d.The patient had a cough of yellow-green purulent sputum.Moist rales were heard in bilateral lungs.Renal biopsy showed crescentic glomerulonephritis,and anti-glomerular basement membrane IgG antibody was weakly positive.Chest CT scan revealed multiple inflammations in both lungs.The culture of bronchoalveolar lavage fluid showed the phenomenon of phagocytosis.Sputum fungal smear and fluorescent staining,alveolar lavage fluid culture,next-generation sequencing(NGS)of alveolar lavage fluid indicated a variety of microbial infections.The diagnosis of Goodpasture syndrome complicated with lung infection was considered.He was discharged after receiving renal replacement,immunosuppression,and anti-infection therapies.Three months later,the patient was transferred to ICU due to“severe pneumonia,septic shock,and respiratory failure”and eventually died.A total of 27 cases of Goodpasture syndrome complicated with pulmonary infection were researched.The common pathogens of pulmonary infection were invasive pulmonary Aspergillus,Pneumocystis carinii,Mycobacterium tuberculosis and cytomegalovirus,etc.Thirteen patients died,and 4 of them died of respiratory failure and/or respiratory infection.Conclusion Extensive attention should

关 键 词：肺出血-肾炎综合征 肺部感染 白念珠菌 丙酸棒杆菌 二代测序 

分 类 号：R563[医药卫生—呼吸系统] R692.3[医药卫生—内科学]