米卡芬净治疗肾移植术后肺部真菌感染的临床观察

目的评价米卡芬净治疗肾移植术后肺部真菌感染的疗效及安全性。方法 24例肾移植术后真菌感染患者给予米卡芬净治疗,取米卡芬净100mg用生理盐水230ml稀释后每日1次静脉滴注,重症患者用量加大至150mg/d,连用10～14d,临床症状基本得到控制后剂量减为50mg/d,连用时间为5～7d。同时调整免疫抑制剂方案等,观察其疗效及不良反应。结果 24例患者中痊愈10例,显效8例,进步2例,无效4例,有效率为75%。治疗过程中仅有2例出现轻微的肝功能异常,2例出现低钾血症,不良反应发生率为17%,未观察到严重的不良反应。22例患者治疗前后肾功能维持稳定,另2例肾移植术后移植物功能延迟恢复期间发生肺部真菌感染的患者,治疗期间肾功能有所改善。结论米卡芬净治疗肾移植术后肺部真菌感染疗效肯定,不良反应少。

Analysis of micafungin in the treatment of pulmonary fungal infection in renal transplantation recipients

Objective To investigate the efficacy and safety of micafungin administration in treating pulmonary fungal infections after renal transplantation.Methods Twenty-four recipients of pulmonary fungal infections after renal transplantation were treated by micafungin injection.Micafungin（100 mg）diluted by normal saline（230 ml）was administered once every day by intravenous injection.The dosage of micafungin for severe patients was 150 mg/d and was used for 10-14 d continuously.Once the clinical symptoms were controlled,the dosage was decreased to 50 mg/d for another 5-7 d.The immunosuppressant was adjusted by observing the effectiveness and adverse reaction.Results In the 24 patients,10 cases were cured,8 cases improved,2 cases progressed and 4 cases showed no effect at all.The overall effective rate was 75 %.No severe side effect but slight liver dysfunction in 2 cases and hypokalemia in 2 cases were found during the treatment,and adverse reaction rate was 17 %.The graft function of 22 patients kept stable during treatment.Two cases with delayed graft function developed pulmonary fungal infection during renal recovery.And the renal function was improved during treatment.Conclusion Micafungin is an effective and safe therapy in treating pulmonary fungal infections after renal transplantation.