肾移植后重症卡氏肺囊虫肺炎1例

背景:卡氏肺囊虫肺炎是肾移植后较为少见的严重并发症,起病隐匿,临床症状不典型,病情进展迅速,死亡率高。目的:探讨肾移植后并发卡氏肺囊虫肺炎的临床特点、治疗及预防方法。方法:回顾性分析2011年在西安交通大学医学院第一附属医院诊断治疗的1例肾移植后并发重症卡氏肺囊虫肺炎患者的临床资料。结果与结论:1例62岁女性同种异体肾移植患者术后100d出现发热及进行性低氧血症,经支气管镜检及肺泡活检检出卡氏肺囊虫,病情进展迅速,经口服复方磺胺甲噁唑片、呼吸机辅助通气及对症支持治疗后治愈。结果提示具有危险因素的患者在出现发热及进行性低氧血症时应提高警惕,预防应用复方磺胺甲噁唑片等药物尤为重要;另外免疫抑制剂的调整在卡氏肺囊虫肺炎的治疗过程中很关键,CD4+/CD8+可作为一项有益的指导指标。

One case of severe pneumocystis carinii pneumonia after renal transplantation

BACKGROUND： Pneumocystis carinii pneumonia is a serious complication after renal transplantation. It is rare and onset is insidious. A typical clinical symptoms, rapid progression and high mortality are observerd in this desease. OBJECTIVE： To investigate the clinical features, treatment and prevention methods of pneumocystis carinii pneumonia after renal transplantation. METHODS： The clinical data of one case of severe pneumocystis carinii pneumonia after renal transplantation that selected from the First Affiliated Hospital of Xi’an Jiaotong University School of Medicine were retrospectively analyzed. RESULTS AND CONCLUSION： A 62-year-old female kidney transplantation recipient suffered from fever and progressive hypoxemia at 100 days after the transplantation. Pneumocystis carinii pneumonia was detected by bronchoscopy and alveolar biopsy. Through compound sulfamethoxazole and trimethoprim tablets administration, mechanical ventilation and other supportive treatment, the patient was cured. Prevention is particularly important in pneumocystis carinii pneumonia because the rapid progression and high mortality. Bronchoscopy should be carried out early in the patients with risk factors especially those have presented clinical symptoms such as fever and hypoxemia. Immunosuppressive agents should be adjusted carefully in the course of treatment of pneumocystis carinii pneumonia. The ratio of CD4＋ /CD8＋ may be a useful index to the adjustment of immunosuppressive agents.