摘要
目的了解糖皮质激素联合免疫抑制剂治疗肾脏疾病并发肺部机会性感染的特点和治疗经验。方法回顾性总结2007年2月至2008年5月解放军总医院肾脏科和急诊科收治的11例应用糖皮质激素联合免疫抑制剂治疗后出现严重肺部感染的肾脏疾病患者,分析患者的临床资料和随访结果。结果所有患者呼吸系统症状均在治疗8周后出现,进行性呼吸困难为主要临床表现,5例患者出现呼吸衰竭,肺部影像学显示为两肺局灶性或弥漫性毛玻璃样病变,免疫学检查显示患者免疫功能基本正常,病原学检查所有患者血清人类免疫缺陷病毒(H IV)抗体阴性,1例患者血清巨细胞病毒IgM抗体阳性,1例痰培养烟曲霉菌阳性,其余患者未查到病原体,患者分别给予抗病毒和抗真菌感染或二者联合治疗,根据患者呼吸衰竭严重程度辅以无创或有创呼吸机辅助呼吸,最终2例患者死亡,其余患者病情好转出院,随访1个月至1年肺功能恢复正常。结论肾脏病患者应用糖皮质激素联合疫抑制剂治疗过程中要警惕肺部机会性感染的发生,及时诊断和早期行综合治疗有利于改善患者预后。
Objective To learn characteristic of opportunistic lung infections in patients treated with concomitant application of immunosuppressive drugs and corticosteroids for their renal diseases. Methods Retrospectively study clinic data of 11 patients who acquired opportunistic lung infections when they accepted concomitant treatment of immunosuppressive drugs and corticosteroids in oder to relieve renal diseases. Results Gradual dyspneas were main symptoms of patients, which happened after 8 weeks＇ application of immunosuppressive drugs and corticosteroids. Respiratory failure happened in 5 patients. Computerized tomography examination showed focal or diffuse infitration patch or ground glass opacification which distributed in bilateral lung fields. Serum cytomegalovirus （CMV） IgM antibody of one patient was positive, and aspergillus fumigatus was found in another patient＇s sputum culture. No evidence of microorganism was found in other patients. Antivirus and/or antifangus drugs were applied for treatment. Mechanical ventilations were applied when necessary. Finally all patients survived except two. Their lung functions recovered within 1 to 12 months. Conclusion Opportunistic lung infections may happen after application of immunosuppressive drugs and corticosteroids in patients with renal disease. Early diagnosis and treatment will improve patients＇ survival rate.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2009年第4期346-349,共4页
Chinese Journal of Practical Internal Medicine
关键词
糖皮质激素
免疫抑制剂
肾脏疾病
机会性感染
corticosteroids
immunosuppressive drugs
renal diseases
opportunistic lung infections
