肾移植术后并发卡氏肺孢子虫肺炎

目的:讨论肾移植术后并发卡氏肺孢子虫肺炎(PCP)的早期诊断和治疗。方法:对6例肾移植术后并发PCP患者的临床资料进行分析和总结。结果:6例患者经支气管镜肺泡穿刺活检和支气管肺泡灌洗确诊。PCP发病于术后95～172d,一经确诊,根据肾功能及耐受情况予以复方新诺明SMZco(SMZ50～70mg/(kg.d)TMP10～14mg/(kg.d)治疗3周,同时根据患者外周血CD4+计数及CD4+/CD8+比值调整免疫抑制方案,6例患者均治愈。结论:PCP确诊有赖于肺组织活检或肺泡灌洗找到病原体,必要时诊断性治疗不失为有效方法。治疗首选SMZco,但剂量应结合患者肾功能和耐受情况,并根据患者免疫状态调整免疫抑制方案。

Pneumocystis carinii pneumonia(PCP)in patients with renal transplantation

Objective:To investigate the early diagnosis and treatment of pneumocystis carinii pneumonia in patients with renal transplantation.Methodology:From April,2001 to December,2008,we had 935 paitents with renal allograft.The clinical data and laboratory parameters of six cases who developed PCP were colletted in this study.Results:All of six patients were male and diagnosed as PCP between 95～172 days after renal transplantation.They showed fever and cough early,then developed dyspnea or even ARDS and represented interstiatial pneumonia in CT or X-ray examinations.The defined diagnosis of PCP was established by looking for pneumocystis carinii with visualization of pathogen in bronchial veolar lavage(BAL)samples.The immnosuppressive regiment was regulated according to the number and ratio of blood CD4~+/CD8~+.All patients were subjected to the treatment of SMZcoSMZ 50～70established by visualization of pathogen in BAL samples.SMZco is still most commonly used drug for PCP at present.The scheme of immuosuppressive agent for patients with PCP must be adjusted according to the number and ratio of blood CD4~+/CD8~+.