Aspergillus pneumonia in renal transplant recipients

Background Filamentous fungal infections are associated with a high morbidity and mortality in solid organ transplants The present study aimed to investigate the aspergillus pneumonia in renal transplant recipients, and its diagnosis as well as treatment. Methods Approximately 2000 cases of renal transplants were retrospectively studied and we focused on cases hospitalized during August 1, 2005 and February 1, 2007, as the study period. The clinical database and electronic records were analyzed. Recently published literature was reviewed. Results There was more diabetes and hypertension in the infected group than in the non-infected group （86% vs 62% and 57% vs 39%, respectively）. Eighty-six percent of recipients from the infected group had delayed graft function. Seven cases with aspergillus pneumonia were identified based on either fungal culture or radiology. Of the 7 cases, 4 died in a few days after diagnosis. Liposomal amphotericin B was used as a first-line therapy. Conclusions Incidences of fungal infection are increasing among renal transplant recipients. Early diagnosis and treatment are critical steps in curing aspergillosis.     

肾动脉栓塞3例临床分析并文献复习

目的探讨肾动脉栓塞引发急腹症的临床特点及诊断、治疗方法。方法总结我院收治的3例肾动脉栓塞患者临床资料。3例患者均以"突发性腹痛"为主要症状,均合并房颤或其余部位动脉血栓病史。患者均未能在第一时间做出正确诊断,2例诊为"肾绞痛",1例考虑为"主动脉夹层"。结果3例患者均通过腹部CT血管造影做出确定诊断,2例患者为局限性肾段梗死,行抗凝治疗后症状好转;1例患者为肾动脉主干梗塞,且时间超过24 h,不适宜行介入治疗,最终行肾脏切除术。结论 CT血管造影可作为肾动脉栓塞确诊的首选方法,早期诊断、早期治疗是挽救肾动脉栓塞患者肾脏功能的关键。     

糖尿病终末期肾病肾移植的临床研究

目的探讨糖尿病人行肾移植术的临床处理特点.方法回顾性分析了80例糖尿病尿毒症的肾移植术.结果术后移植肾功能延迟恢复(DGF)发生率为17.5%,显著高于非糖尿病受者,DGF发生原因主要是外周血管硬化和心血管并发症,后者是术后的主要并发症,包括猝死2例、急性心肌梗死1例、急性左心衰2例和室性心率失常2例.结论糖尿病尿毒症病人行肾移植术的主要困难在于潜在的外周动脉硬化和冠状动脉病变,术前应做好冠心病的筛查和外周动脉硬化病变的评估,术后应常规行抗凝治疗.     

重症肺炎7例临床分析及文献复习

目的探讨重症肺炎的临床特点、诊断、治疗方法,以提高其诊断率和治愈率.方法回顾性总结1999～2002年收住北京军区总医院的重症肺炎7例,并结合文献对其临床表现、影像学特点、痰培养、血气分析、诊断及治疗方法进行分析.结果重症肺炎诊疗不及时,死亡率较高,早期出现严重的呼吸窘迫症状,血流动力学不稳定,需要吸入高浓度的氧,呼吸频率快.动脉血氧示Ⅰ型呼衰3/7例,Ⅱ型呼衰4/7例,血压低于90/60 mmHg (1 mmHg＝0.133 kPa)7/7例,X线表现1/7例累及左肺,3/7例累及右肺,3/7例累及双肺.痰培养1/7例为阴沟杆菌,1/7例为鲍氏不动杆菌,1/7例为产酸克雷伯菌,2/7例为金黄色葡萄球菌,1/7例为肠球菌,1/7例为绿脓杆菌.主要治疗手段为综合治疗.预后取决于治疗的时机、选用抗生素的种类.结论依据临床特点,确诊时机、治疗手段,调整抗生素的用药原则来提高临床治愈率.     

蛋白A免疫吸附治疗高致敏肾移植受者1例报告并文献复习

目的肾脏移植的致敏性是目前临床面临的一大难题,高致敏受者接受移植的机会大大减少,我们对1例高致敏受者肾移植围手术期采用蛋白A免疫吸附疗法配合免疫抑制治疗,观察其临床效果,结合文献评估疗效.方法受者采用蛋白A免疫吸附成功进行肾移植病例,同时回顾通过国内外文献检索得到的蛋白A免疫吸附治疗肾移植高致敏受者的病例.结果结合我们目前的病例,分析已被报道的66例(国内30例,国外36例)蛋白A免疫吸附治疗肾移植高致敏受者的病例,发现大部分患者采用了蛋白A免疫吸附可以明显降低IgG、IgM、IgA等,PRA从术前30%～100%降低到术后30%以下,65例成功进行了肾移植.结论 Protein A免疫吸附可以清除体内免疫球蛋白疗效明显,结合免疫抑制治疗使肾移植高致敏受者成功接受肾移植,提高移植肾远期存活率.     

肺错构瘤191例临床分析及文献复习

目的 总结肺错构瘤的临床特点、影像特征、诊断、治疗方法及预后.方法 回顾性研究北京协和医院1983-2010年间病理确诊191例肺错构瘤的临床资料并结合文献复习讨论.结果 75-39%发生于40～70岁之间,平均50.86岁,男:女为1.247:1.63.87%无症状.均行CT,12.3%见爆米花样钙化,仅10.5%术...     

Immunosuppressant dose reduction and long-term rejection risk in renal transplant recipients with severe bacterial pneumonia

INTRODUCTION

Due to lifelong immunosuppression, renal transplant recipients (RTRs) are at risk of infectious complications such as pneumonia. Severe pneumonia results in respiratory failure and is life-threatening. We aimed to examine the influence of immunosuppressant dose reduction on RTRs with bacterial pneumonia and respiratory failure.

METHODS

From January 2001 to January 2011, 33 of 1,146 RTRs at a single centre developed bacterial pneumonia with respiratory failure. All patients were treated using mechanical ventilation and aggressive therapies in the intensive care unit.

RESULTS

Average time from kidney transplantation to pneumonia with respiratory failure was 6.8 years. In-hospital mortality rate was 45.5% despite intensive care and aggressive therapies. Logistic regression analysis indicated that a high serum creatinine level at the time of admission to the intensive care unit (odds ratio 1.77 per mg/dL, 95% confidence interval 1.01–3.09; p = 0.045) was a mortality determinant. Out of the 33 patients, immunosuppressive agents were reduced in 17 (51.5%). We found that although immunosuppressant dose reduction tended to improve in-hospital mortality, this was not statistically significant. Nevertheless, during a mean follow-up period of two years, none of the survivors (n = 18) developed acute rejection or allograft necrosis.

CONCLUSION

In RTRs with bacterial pneumonia and respiratory failure, higher serum creatinine levels were a mortality determinant. Although temporary immunosuppressant dose reduction might not reduce mortality, it was associated with a minimal risk of acute rejection during the two-year follow-up. Our results suggest that early immunosuppressant reduction in RTRs with severe pneumonia of indeterminate microbiology may be safe even when pathogens are bacterial in nature.     

肾移植受者合并肺孢子菌肺炎的CT和肺功能观察

目的 探讨肾移植受者合并肺孢子菌肺炎(PCP)的CT和肺功能的动态变化.方法 对2002至2006年期间确诊的肾移植术后合并肺孢子菌肺炎的16例患者,进行胸部CT、血气分析和肺功能动态变化的回顾性研究.结果 16例患者确诊为PCP病例,年龄(36±11)岁,肾移植术后时间(4.3±2.1)个月,院外病程(4.5±1.9)d.入院后胸部CT均表现为两肺渗出、实变为主,比病程刚起时明显进展.部分还表现为渗出性病灶内多发的局灶性肺气肿样改变.治疗后肺部阴影开始吸收,病程2个月CT上遗留少许纤维灶.肺功能异常急性期表现为限制性通气功能障碍和弥散功能降低,第3周时通气功能异常即逐渐恢复正常,第4周弥散功能明显好转,病程第3个月内肺功能完全恢复.结论 肾移植合并PCP患者胸部CT以肺泡病变(渗出和实变为主)为特点,可有局部肺气肿样改变.肺功能异常急性期以限制性通气功能障碍和弥散功能下降为主;治疗若有效,病程第3个月内肺功能异常可完全恢复.     

喉结核29例病例分析及文献回顾

当今，结核病疫情在全球呈进一步蔓延趋势，肺外结核的发病率也随之增加，咽喉部作为结核杆菌肺外感染的好发部位，其发病趋势类似，由于临床医生对其警惕性不高，容易漏诊误治，造成病情加重，影响预后。现收集我院2005年1月～2007年12月收治的29喉结核病例并分析如下。     

肾移植受者BK病毒感染的临床诊断

目的 探讨肾移植受者BK病毒感染的诊断方法、监测指标.方法 采集234例肾移植受者的血、尿样本,行BKV尿沉渣细胞学计数与实时荧光定量PCR检测方法.结果 234例受者的尿Decoy细胞、BK病毒尿症与病毒血症的阳性率分别为33.3%、33.3%和16.2%.尿Decoy细胞阳性者Decoy细胞中位数水平为6个/10HPF,BKV DNA阳性者尿液和外周血BKV中位数水平分别为7.62×103 copy/ml和7.61×103 copy/ml.尿液BKV阳性率较外周血明显升高(P=0.000).尿液Decoy细胞计数与尿液BKV含量相关(γ=0.59,P=0.000),但尿液和外周血中BKV含量无明显相关性(P=0.14).结论 肾移植受者易发生BKV再活化,定量尿沉渣细胞学检测简单、易行、敏感,可以做为BKV活化的指标,间接反映肾脏病理情况,也可检测血、尿BKV DNA了解病毒活化情况、筛查BKV相关的移植肾肾病.