肾移植术后并发卡氏肺孢子菌肺炎的治疗方案选择  

Treatment of pneumocysis carinii penumonia after kidney transplantation

作　　者：武小杰 杨硕[1] WU Xiao-jie;YANG Shuo(Wuhan Hospital of Traditional Chinese and Western Medicine,Hubei Wuhan 430022,China)

机构地区：[1]武汉市中西医结合医院呼吸与危重症医学科,湖北武汉430022

出　　处：《内科急危重症杂志》2023年第5期393-396,共4页Journal of Critical Care In Internal Medicine

摘　　要：目的:探讨肾移植术后并发卡氏肺孢子菌肺炎(PCP)患者用卡泊芬净治疗PCP感染的疗效。方法:将125例肾移植后并发PCP患者分为磺胺组(42例)、卡泊芬净组(37例)和磺胺+卡泊芬净组(46例),比较3组临床特征,分析各组治疗后患者体温恢复正常时间、卡氏肺孢子菌(PC)核酸转阴时间和治疗结局。结果:治疗前,3组患者年龄、性别、发热症状及实验室检测(G实验和乳酸脱氢酶)方面比较,差异无明显统计学意义(P均>0.05)。治疗后,磺胺组、卡泊芬净组、磺胺+卡泊芬净组体温恢复正常时间分别为(7.9±1.4)d,(8.1±1.7)d和(7.7±1.5)d,组间比较,差异无明显统计学意义(P>0.05);PC核酸转阴时间分别为(13.4±1.6)d、(16.3±2.9)d、(13.9±2.5)d;卡泊芬净组PC核酸转阴时间明显长于磺胺组、磺胺+卡泊芬净组(P均<0.05),磺胺组和磺胺+卡泊芬净组比较,差异无明显统计学意义(P>0.05);3组间的治疗结局比较,差异无明显统计学意义(P均>0.05)。结论:卡泊芬净单药治疗PCP能获得肯定的疗效,包括体温恢复正常、PC核酸转阴和治愈出院。卡泊芬净对于肾移植术后PCP患者的治疗是一个较好的选择。Objective:To investigate the efficacy of carpofungine in treating Pneumocysis carinii penumonia(PCP)after kidney transplantation.Methods:Totally,125 patients with PCP after kidney transplantation were divided into sulfonamide group(n=42),casposungin group(n=37 cases),and sulfonamide+casposungin group(n=46 cases).The clinical features of the three groups were compared,and the time of temperature recovery,the negative conversion of pneumocystis carinii(PC)nucleic acid in each group after different treatment projects were analyzed.Results:Before the treatment,there were no significant differences in age,gender,fever symptoms,and laboratory tests(G experiment and LDH)among the three groups(P>0.05).After treatment,the days of the body temperature to the normal level in the sulfonamide group,casposungin group,and sulfonamide+casposungin group were(7.9±1.4),(8.1±1.7),and(7.7±1.5),respectively,with no significant difference among the three groups(P>0.05);The time of PC nucleic acid negative conversion in the sulfonamide group,casposungin group,and sulfonamide+casposungin group was(13.4±1.6),(16.3±2.9),and(13.9±2.5)days,respectively.The time of PC nucleic acid negative conversion in the casposungin group was significantly longer than that in the sulfonamide group and the sulfonamide+casposungin group,with a significant difference(P<0.05),but there was no significant difference between the sulfonamide group and the sulfonamide+casposungin group(P>0.05).There was no significant difference in treatment outcomes among the three groups(P>0.05).Conclusion:Carpofungin monotherapy can achieve a positive therapeutic effect on PCP,including temperature decline to normal level,the negative conversion of PC nucleic acid,and cure and discharge.Carpofungin is a good choice for the treatment of PCP after kidney transplantation.

关 键 词：复方磺胺甲噁唑 卡泊芬净 卡氏肺孢子菌肺炎 肾移植 治疗结局 

分 类 号：R563.1[医药卫生—呼吸系统]