摘要
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25例肾移植术后肺部真菌感染患者的临床资料,其中男16例,女9例,平均年龄46.2岁,发病时间平均为术后137.8天。结果:25例患者中,白色念珠菌感染6例,光滑念珠菌感染感染1例,假丝酵母菌感染1例,热带念珠菌感染1例,曲霉菌感染1例,新型隐球菌感染1例,镜检见菌丝感染2例,培养阴性12例;合并感染11例。13例培养或镜检阳性者中,采用伊曲康唑治疗有效10例,死亡1例,2例改用两性霉素B脂质体治疗,均康复;12例培养或镜检均阴性者中,采用抗细菌和抗病毒治疗均无效,其中7例采用伊曲康唑治疗3天,5例有效,2例无效后改用两性霉素B脂质体治疗,5例应用醋酸卡泊芬净治疗,患者均康复。本组25例患者在积极抗真菌的同时给予呼吸支持、调节免疫抑制剂剂量、经验性联合抗微生物、小剂量激素及其他支持治疗等,24例康复出院,1例死亡。结论:肺部真菌感染是肾移植术后常见并发症。早期诊断并应用新型抗真菌药、调节免疫抑制剂剂量、给予经验性联合抗微生物、小剂量激素等,治疗效果良好,治愈率高。
Objective：To investigate the diagnosis and treatment of fungal infections of the lungs following renal transplantation. Methods：A total of 25 cases（16 males and 9 females, mean age of 46.2 years） fungal infections of the lungs after renal transplantation were retrospectively analyzed. The mean time from post-operation to onset of the infection was 137.8 days. Results：Among the 25 cases, 6 were infected with candidiasis, 1 with candida parapsilosis, 1 with Candida mycoderma, 1 with Candida tropicalis, 1 with aspergillosis, 1 with cryptococcosis neoforroans. 11 cases out of 25cases were coinfected. 12 cases were negative for fungus-culturing testand detectation under microscope. Mycelwas detected under microscopein the other 2cases. 13 cases were cured with Itraconazole. 10 were cured and 2 were cured with the replacement of amphoterlcin B and ldied. Of 12 cases who were negative for fungus-culturing testand deteetation under microscope, 7 cases were treated with Itraconazole initially. 5 were cured and 2 were cured with the replacement of amphoterlcin B. The other 5 cases were cured with caspofungin acetate. All 25 cases also received the treatment of breathing support, adjustment ofimmunodepressantdose, experimental antimicrobial unification, applicationof low dose glueocorticoid, supportive treatmentand so on. 24 cases were cured and 1 died. Conclusions： Fungal infection of the lungs is a commoncomplication after renal transplanta- tion. Early diagnosis and comprehensively treatment may achieve satisfactory effects. Treatment include application of new antifungal, breathing support, adjustment ofimmunodepressantdose, experimental antimierobial unification,applicationof low dose glucocorticoid, supportive treatmentand so on.
出处
《临床泌尿外科杂志》
2008年第9期690-693,共4页
Journal of Clinical Urology
关键词
肾移植
真菌感染
诊断
治疗
Renal transplantation
Fungal infection
Diagnosis and treatment
