肾移植后合并卡氏肺孢子虫肺炎：10年同一机构378例中的12例

背景：在肾移植后早期,由于免疫抑制剂用量较大,患者的免疫功能明显受到抑制,卡氏肺孢子虫肺炎在此期间相对高发。目的：分析肾移植后并发卡氏肺孢子虫肺炎的临床特点、诊治及预防。方法：收集佛山市第一人民医院肾内科2000-11/2010-07肾移植378例中并发卡氏肺孢子虫肺炎12例患者的临床资料,分别对其发病时间、易感因素、诊断方法、临床表现及治疗方案、预防效果进行回顾性分析。结果与结论：发病时间为移植后5.3（3~11）个月。12例患者均有发热,体温达38.0～40.2℃,气促及紫绀。9例轻微咳嗽,5例少量白痰,1例红色泡沫痰。5例合并细菌感染,2例合并真菌感染,2例合并巨细胞病毒感染,1例合并结核。服用他克莫司患者感染发生率为7.8%（7/89）,服用环孢素A患者感染发生率为1.7%（5/289）。9例使用呼吸机,2例使用呼吸机无创性连续鼻或口鼻面罩治疗。8例痊愈,2例治疗中出现血小板减少致脑出血死亡,1例合并真菌感染死亡,1例合并血气胸死亡。治疗期间,无排斥反应发生。说明早期诊断,联合用药,减少免疫抑制剂用量是提高卡氏肺孢子虫肺感染治愈率的关键。

12/378 cases of kidney transplantation complicated with pneumocystis carinii pneumonia in the same institution within 10 years

BACKGROUND：The immunity of patients can be obviously suppressed since a large amount of immunosuppressor is used in the early stage after kidney transplantation, therefore pneumocystis carinii pneumonia （PCP） tends to have a high incidence during this period. OBJECTIVE：To explore the clinical features, diagnosis, treatment, and prevention of PCP after kidney transplantation. METHODS： Twelve cases complicated with PCP were collected from 378 cases of kidney transplantation patients from the Nephrology Department of the First People’s Hospital of Foshan from November 2000 to July 2010. And then the time of onsets, predisposing factors, diagnostic methods, clinical manifestations, therapeutic schedule and prophylactic efficiency were retrospectively analyzed. RESULTS AND CONCLUSION：The time of onsets was 5.3 （3-11） months after kidney transplantation. Twelve cases of patients presented with polypnea and cyanosis with a high fever of 38.0-40.2 ℃. Nine cases experienced slight cough. Five cases coughed with a small amount of white sputum and one case with red frothy sputum. Five cases were complicated with bacterial infection, two with fungal infection, two with cytomegalovirus infection and one with tuberculosis. The infection rate was 7.8% （7/89） in patients administrated with Tacrolimus, while1.7% （5/289） in those administrated with cyclosporine A. Ventilators were applied in nine cases and two cases were treated with bi-level positive airway pressure （BIPAP） for assisted respiration. Eight cases fully recovered. However, two cases died of cerebral hemorrhage due to thrombocytopenia during the treatment, one case died of fungal infection and one case died of hemopneumothorax. No exclusive reaction was found during the treatment. These indicated that the key to raising the curative rate of PCP was early diagnosis, drug combination and decreased immunosuppressor dosage.