器官移植受者诺卡菌病诊疗进展  

Progress on the diagnosis and treatment of nocardiosis in organ transplant recipients

作　　者：巨春蓉[1] 门同义 薛武军[3] 李时悦[1] Ju Chunrong;Men Tongyi;Xue Wujun;Li Shiyue(Guangzhou Respiratory Health Research Institute,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;不详)

机构地区：[1]广州医科大学附属第一医院广州呼吸健康研究院,广州510120 [2]内蒙古医科大学附属医院 [3]西安交通大学第一附属医院

出　　处：《器官移植》2024年第6期868-875,共8页Organ Transplantation

基　　金：呼吸疾病国家重点实验室广州呼吸健康研究院国家呼吸中心临床自主探索项目(SKLRHQN20205);广东省钟南山医学基金会(ZNSA-2020013);广东省自然科学基金(2022A1515012216);广州市临床特色技术项目(2023C—TS10);广州医科大学科研能力提升计划重大临床研究项目(GMUCR2024-01007)。

摘　　要：诺卡菌感染后引起的组织与器官损害统称为诺卡菌病。实体器官移植受者(SOTR)因接受免疫抑制治疗,免疫功能较弱,各种病原体感染的机会明显增加,包括诺卡菌感染。既往诺卡菌病诊断具有一定难度,随着分子生物学等检测手段的出现,其诊断率已显著提高。诺卡菌不仅容易导致肺部坏死性病变,还可能侵犯累及其他器官组织,如颅内感染及皮肤软组织感染,并可发展为全身性播散性感染。对SOTR而言,诺卡菌病是一种潜在致命的疾病,病死率高达30%。因此,本文就SOTR中常见诺卡菌病的临床特点、新型诊断技术及不同的抗感染治疗策略等方面进行综述,以期为临床SOTR诺卡菌病的防治提供参考。Nocardiosis is a collective term for tissue and organ damage caused by Nocardia infection.Solid organtransplant recipients(SOTR)are at an increased risk of various pathogen infections,including Nocardia infection,due toimmunosuppressive therapy which weakens their immune function.The diagnosis of nocardiosis has been challenging inthe past.With the advent of molecular biology and other diagnostic methods,the diagnostic rate has significantlyimproved.Nocardia not only prone to cause necrotic pulmonary lesions but also invade other organs and tissues,such asintracranial infections and skin soft tissue infections,and can develop into systemic disseminated infections.For SOTR,nocardiosis is a potentially fatal disease with a fatality as high as 30%.Therefore,this article reviews the clinicalcharacteristics of common nocardiosis in SOTR,new diagnostic technologies,and different anti-infective treatmentstrategies,aiming to provide a reference for the prevention and treatment of nocardiosis in clinical SOTR.

关 键 词：诺卡菌病 诺卡菌 播散性感染 器官移植 免疫抑制 抗菌药物 宏基因组测序 药物不良反应 

分 类 号：R617[医药卫生—外科学] R378[医药卫生—临床医学]