背景:肾移植后肺部感染病情进展快,治疗中免疫抑制剂的调整至关重要,关系到肺炎的转归及移植肾功能的维护,因此对病情做到准确判定,选择合适的治疗方案对肾移植后肺炎的治疗具有重要意义.目的:总结肾移植后肺部感染分期诊治情况与经验,探索恰当的治疗方案.方法:回顾性分析178例肾移植后肺部感染患者进行分期诊治的临床资料.根据患者肺部炎症的病情进展,将肺部感染分为3期:感染早期、感染进展期、重症肺部感染期,予以不同的免疫抑制调整联合糖皮质激素抗炎治疗,在无确切临床病原学资料时,给予广谱抗生素、抗病毒、抗霉菌等药物联合治疗,病原学明确后,给予针对性抗感染治疗.结果与结论:①178例肾移植后肺部感染患者,发病时间为肾移植后1-6个月90例(其中2-4个月78例), 6-12个月16例,12-24个月14例,24-36个月12例,大于36个月46例;②肺部感染早期临床症状不突出,发热是最早或主要表现,有时是唯一的表现,部分病例有干咳、咳白色黏液痰,混合细菌或真菌感染时痰量增多,肺部体征多不明显,影像学检查主要表现为肺部间质性炎症;③178例患者中,173例治愈,治愈率97.2%,临床效果显著;④5例死亡病例中,3例死于急性呼吸衰竭,2例死于多器官功能衰竭.其中3例出现移植肾急性排异反应,6例出现移植肾功能受损,3例移植肾急性排异反应均成功逆转;⑤分析结果表明,肾移植后肺部感染起病大多隐匿,病程进展迅速.依据病情对肺部感染进行分期,及时调整免疫抑制剂联合激素实施个体化治疗方案,调整机体免疫抑制状态,及时明确肺部感染的病原体,采用针对性抗感染治疗,有助于提高肾移植后肺部感染治愈率和移植肾功能稳定率.%BACKGROUND: Progress of lung infection after kidney transplantation is rapid, and the adjustment of immunosuppressive drugs is critical, which related to the prognosis of pneumonia and the maintenance of renal function. Therefore, an accurate diagnosis for the pneumonitis post-kidney transplantation is of great significance for choosing the appropriate treatment scheme. OBJECTIVE: To summarize the diagnosis and treatment of pulmonary infection at different periods after kidney transplantation, and then to explore the proper treatment scheme. METHODS: A retrospective analysis of 178 cases of pulmonary infection at different periods after kidney transplantation was performed. According to the progress of patients with lung inflammation, the lung infection was divided into three phases: early, advanced, and phases, and then given different immunosuppressive treatments combined with glucocorticoids; for those with unclear pathogens, given broad-spectrum antibiotics, antiviral, anti-fungal and other drugs, and targeted anti-infective treatment was underwent once pathogen was confirmed. RESULTS AND CONCLUSION: (1) There were 178 patients with pulmonary infection after kidney transplantation, 90 cases occurred at postoperative 1-6 months (78 cases at postoperative 2-4 months), 16 cases occurred at postoperative 6-12 months, 14 cases occurred at postoperative 12-24 months, 12 cases occurred at postoperative 24-36 months, and 46 cases occurred at postoperative more than 36 months. (2) The clinical symptoms of pulmonary infection at the early stage were not obvious, fever was the earliest or primary symptom, and sometimes it was the only symptom. In some cases, the patients appeared with dry cough, expectoration with white mucous sputum, and the amount of sputum increased if infected with mixed bacteria or fungus. But the pulmonary signs are unobvious, and the main imageology feature of lung tissues showed interstitial inflammation. (3) Totally 173 patients were cured, the recovery rate reached to 97.2% and the curative efficacy was satisfactory. (4) Among five patients who dead from pulmonary infection, three were died from acute respiratory failure, and two were for multiple organ failure. Three patients presented with acute rejection to transplant kidney and were cured, and six patients suffered impaired renal function. (5) These results suggest that there is potential risk for pulmonary infection after renal transplantation and it develops rapidly. Based on the situation of pulmonary infection, the physicians can adjust the dose of immunosuppressor and hormone in time, so as to improve the immunosuppressive state and clarify the pathogen for pulmonary infection, then corresponding treatment for anti-infection will be offered, which is beneficial to increase the recovery rate of pulmonary infection and improve the stability of transplanted renal functions.
展开▼
