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 Depart...