实体器官移植受者侵袭性真菌病的临床治疗管理  

Clinical treatment and management of invasive fungal disease in recipients of solid organ transplantation

作　　者：Arnoux Robenson Jean 周佩军[1] Arnoux Robenson Jean;Zhou Peijun(Department of Urology,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院泌尿外科,上海200025

出　　处：《器官移植》2024年第1期151-159,共9页Organ Transplantation

基　　金：上海市保健医疗科研课题(202240032)。

摘　　要：随着实体器官移植(SOT)的广泛开展,SOT受者术后侵袭性真菌病(IFD)的发生率呈逐年上升趋势。近年来,对于SOT受者预防性抗真菌治疗意识不断增强,随之也出现了真菌耐药问题,导致原有标准化抗真菌治疗的效果不理想。而药物相互作用、药物的肝肾毒性等问题,也是临床医师需面对的挑战。本文综述了目前三唑类、棘白菌素类以及多烯类抗真菌药物与免疫抑制药之间的药物相互作用和肝肾毒性等特征,并总结了目前不同种类SOT受者术后IFD的预防策略以及感染不同病原体导致IFD的治疗策略,旨在为器官移植及相关学科的医师提供参考。With widespread application of solid organ transplantation(SOT),the incidence of postoperative invasive fungal disease(IFD)in SOT recipients has been increased year by year.In recent years,the awareness of preventive antifungal therapy for SOT recipients has been gradually strengthened.However,the problem of fungal resistance has also emerged,leading to unsatisfactory efficacy of original standardized antifungal regimens.Drug-drug interaction and hepatorenal toxicity induced by drugs are also challenges facing clinicians.In this article,the characteristics of drug-drug interaction and hepatorenal toxicity among triazole,echinocandin and polyene antifungal drugs and immunosuppressants were reviewed,and postoperative preventive strategies for IFD in different types of SOT recipients and treatment strategies for IFD caused by infection of different pathogens were summarized,aiming to provide reference for physicians in organ transplantation and related disciplines.

关 键 词：实体器官移植 侵袭性真菌病 药物相互作用 抗真菌治疗 药物浓度监测 侵袭性假丝酵母病 侵袭性曲霉病 耶氏肺孢子菌肺炎 

分 类 号：R617[医药卫生—外科学] S945.13[医药卫生—临床医学]