肾移植术后巨细胞病毒肺炎合并急性呼吸窘迫综合征临床及预后分析

目的分析肾移植术后巨细胞病毒(CMV)肺炎合并急性呼吸窘迫综合征(ARDS)的临床特点及预后因素,为其临床治疗及预后分析提供依据。方法采用病例-对照研究方法。收集广东药学院附属第一医院和中山大学附属第一医院1995年1月至2004年12月肾移植术后CMV肺炎合并ARDS完整病例资料55例,分为死亡组(31例)和生存组(24例),分析其临床表现。采用χ2检验或秩和检验进行死亡危险单因素分析,多因素Lo-gistic回归筛选预后因素。结果肾移植术后CMV肺炎合并ARDS病死率为56.4%,施行机械通气者病死率高达72.5%。统计分析显示,并发症数、X线胸片示肺浸润严重程度、机械通气是肾移植术后CMV肺炎合并ARDS死亡的独立危险因素(P<0.05),优势比(OR值)分别为2.60[95%可信区间(CI)1.00~6.76]、11.83[95%CI(1.14~123.07)]、19.32[95%CI(1.01~372.02)]。结论肾移植术后CMV肺炎合并ARDS具有极高的病死率,并发症数、X线胸片浸润严重程度、机械通气是肾移植术后CMV肺炎合并ARDS死亡的预后指标。减少肾移植术后CMV肺炎并发ARDS和死亡的主要措施在于移植术后预防性抗CMV治疗。

Clinical features and outcomes of acute respiratory distress syndrome caused by cytomegalovirus pneumonia after kidney transplantation

Objective To analyze clinical manifestation and identify prognostic factors in patients with acute respiratory distress syndrome (ARDS) caused by cytomegalovirus (CMV) pneumonia after kidney transplantation.Methods Fifty five kidney transplant recipients' data were analyzed in a case-control study of patients with a primary discharge diagnosis of ARDS caused by CMV pneumonia.Results The mortality of ARDS after kidney transplantation was 56.4%;when association with mechanical ventilation,it was 72.5%.In multivariate Logistic regression analysis,numbers of complications (odds ratioOR2.60,95% confidence intervalCI1.00~6.76),severity of diffuse infiltrates in chest X-ray (OR 11.83,CI 1.14~123.07),mechanical ventilation (OR 11.83,CI 1.14~123.07) were independent risk factors to death.Conclusion Even in modern era,kidney transplant recipients with ARDS after kidney transplantation are still at high risk for death.Numbers of complications,severity of diffuse infiltrates in chest X-ray,mechanical ventilation are associated with poor outcomes.