肾移植术后肺部真菌感染的诊治

目的探讨肾移植术后肺部真菌感染的诊断与治疗。方法回顾性分析2008年1月至2010年12月广州医科大学附属第三医院收治的12例肾移植术后肺部真菌感染患者的临床资料。结果 12例患者中,真菌培养阳性者5例,其中白假丝酵母3例,曲霉2例。采用伏立康唑抗真菌治疗后治愈11例,死亡1例。与治疗前比较,治疗后患者呼吸频率及血二氧化碳分压降低,血氧分压及氧合指数显著升高,差异有统计学意义(均为P<0.01)。治疗前后患者的血清肌酐、尿蛋白、白蛋白、丙氨酸转氨酶水平的差异无统计学意义(均为P>0.05)。结论肺部真菌感染是肾移植术后的严重并发症,应早期明确诊断,及时使用抗真菌药物,减少免疫抑制剂用量,应用大剂量丙种球蛋白及呼吸机支持治疗。

Diagnosis and treatment of pulmonary fungal infection after renal transplantation

Objective To investigate the diagnosis and treatment of pulmonary fungal infection after renal transplantation. Methods Clinical data of 12 patients with pulmonary fungal infection after renal transplantation in the Third Affiliated Hospital of Guangzhou Medical University from January 2008 to December 2010 were analyzed retrospectively. Results Positive fungus cultivation was observed in 5 cases, including candida albicans in 3 cases and aspergillus in 2 cases. Eleven cases were cured and 1 case died after treatment of voriconazole. Compared with those before treatment, the patients＇ respiratory frequency and partial pressure of blood carbon dioxide decreased, and partial pressure of blood oxygen and oxygenation index increased. There was significant difference （ all in P 〈 0. 01 ）. There was no significant difference in the serum ereatinine, urine protein, albumin, alanine aminotransferase before and after treatment （ P 〉 0. 05 ）. Conclusions Pulmonary fungal infection is a severe complication after renal transplantation. It is important to diagnose early, use antifungal drugs in time, reduce dosage of immunosuppressive agents and use large dose of immunoglobulin and breathing machine.