肾移植术后并发毛霉菌感染2例临床分析  

Diagnostic value and analysis of two cases with Mucor infection after renal transplantation

作　　者：艾雄飞 陈少文 林翀[2] AI Xiongfei;CHEN Shaowen;LIN Chong(Mengla County People's Hospital,Mengla,Yunnan 666300,China;Department of Clinical Laboratory,the Second Affiliated Hospital of the Hainan Medical University,Haikou,Hainan 570311,China)

机构地区：[1]勐腊县人民医院,云南勐腊666300 [2]海南医学院第二附属医院检验科,海南海口570311

出　　处：《中国热带医学》2023年第10期1122-1126,共5页China Tropical Medicine

基　　金：国家科技基础资源调查专项(No.2019FY101200)。

摘　　要：报道2例肾移植患者并发毛霉菌感染的诊断及治疗过程,为毛霉菌感染诊治提供参考依据。病例1,患者男性,因肌酐升高8年余,行同种异体肾移植术,术后25 d肾功能恢复尚可,之后患者突发上腹痛加剧,对腹腔引流液进行病原体培养、涂片镜检、质谱鉴定及宏基因二代测序(next-generation sequencing,mNGS)鉴定,结果显示为小孢根霉,用两性霉素B硫酸胆固醇复合体抗真菌治疗后病情好转出院;病例2,患者男性,有高血压,血肌酐升高7年余入院,行同种异体肾移植术后,移植肾组织培养涂片及组织病理检查均考虑毛霉菌感染,后行“手部肌肉清创术+创面封闭式负压引流术(VSD)”,术后予以两性霉素B抗毛霉菌感染治疗及清创,之后mNGS复测未见毛霉菌感染。2例患者治疗过程中均加用替加环素治疗后出现腹痛,随即诊断为胰腺炎,停药后恢复;患者均为男性,其中1例合并高血压;2例肾移植患者毛霉菌感染经传统的涂片检查作为导向,后经组织病理学检查、mNGS及质谱鉴定技术确诊,1例为小孢根霉感染,另1例为米根霉和小克银汉霉混合感染。肾移植术后由毛霉菌感染患者的诱因多种多样,治疗的关键是早期诊断,选用两性霉B及其脂质体治疗是改善肾移植术后毛霉菌病患者的有效治疗手段。To report the diagnosis and treatment of Mucor infection in two cases of renal transplantation,and to provide reference for diagnosis and treatment of Mucor infection.Case 1,a male patient,who underwent allogeneic kidney transplantation due to increased creatinine for more than 8 years.The renal function had partially recovered 25 days after the operation,but then the patient suddenly got worse epigastric pain.Pathogen culture,smear microscopy,mass spectrometry identification and next-generation metagenomic sequencing(mNGS)were performed on the peritoneal drainage,with the result pointing to Rhizopus microsporus.The patient's condition improved after antifungal treatment using amphotericin B lipid complex(ABLC)and was discharged.Case 2,a male patient with hypertension and increased creatinine for more than 7 years was admitted to the hospital.After allograft kidney transplantation,tissue culture smear and histopathological examination suggested Mucor infection.The patient then underwent a"hand muscle debridement surgery+closed negative pressure drainage(VSD)"procedure,and amphotericin B was given postoperative treatment against Mucor infection and debridement.Subsequent retesting with mNGS showed no signs of Mucor infection.In the course of treatment,two patients developed abdominal pain after treatment with tegacycline,which was immediately diagnosed as pancreatitis and recovered after withdrawal.Both patients being male,with one case associated with hypertension.After initially guiding the diagnosis with traditional smear tests,final confirmation was done using histopathological examination,mNGS and mass spectrometry.One case was infected by Rhizopus microspora,and the other was infected by Rhizopus oryzae and Cunninghamia microbicans.The causes leading to Mucor infection in patients post renal transplantation varied greatly.Early diagnosis is the key to treatment of patients with Mucor infection after renal transplantation.Treatment with amphoteric B and its liposome is an effective means to improve mucormycos

关 键 词：肾移植 毛霉菌 感染 诊断 结局 

分 类 号：R379[医药卫生—病原生物学]