摘要
目的探讨华南地区肺移植受者侵袭性肺部真菌感染(IPFI)的发病率、临床特点及其预后。方法回顾性分析2003年1月至2019年8月在广州医科大学附属第一医院等中国南方地区3所医院接受肺移植的300例受者资料。按照是否存在侵袭性肺部真菌感染分为感染组(IPFI组,93例)和非感染组(nIPFI组,207例),男女比例为254/46例,年龄(54.98±14.2)岁。收集的资料主要包括:症状及体征,影像学表现,气管镜检查,深部痰或支气管肺泡灌洗液病原菌分离及培养,真菌相关的实验室检测,组织病理学检查等。结果至少发生1次IPFI的93例受者中,曲霉菌感染最常见,占56例(60.2%),其后依次为假丝酵母菌感染15例(16.1%)、耶氏肺孢子菌感染13(14.0%)、毛霉菌感染4例(4.3%)、隐球菌感染3例(3.2%),其他少见真菌感染2例(2.2%)。IPFI组与nIPFI组1年的全因死亡率分别为45.2%和26.7%,差异有统计学意义(P<0.05)。结论肺移植术后IPFI发生率高,曲霉菌感染最常见,发病时间多在6个月以后,肺部感染多见;假丝酵母菌病是第二常见真菌病原体,术后早期多见,以气道及吻合口感染多见;肺移植受者IPFI死亡率高,应尽早明确诊断,及时治疗。
Objective To explore the incidence,clinical characteristics and prognosis of invasive pulmonary fungal infection(IPFI)in recipients of lung transplantation(LT)in southern China.Methods From January 2003 to August 2019,retrospective analysis was performed for 300 recipients of lung transplantation at three hospitals in southern China.There were 254 males and 46 females with an average age of(54.98±14.2)years.Clinical data were collected from medical records,including symptoms and signs,imaging studies,bronchoscopy examination,pathogen separation and culture from deep sputum and bronchoalveolar lavage fluid(BALF),fungal-related laboratory tests and tissue pathology.Results Among 300 cases,93(31.0%)had at least one episode of IPFI.The most common pathogen was aspergillosis(60.2%),followed by candida(15 cases,16.1%)and Pneumocystis jeroveci(13 cases,14.0%).Kaplan Meier analysis indicated that all-cause mortality was significantly higher in IPFI group than that in non-IPFI(nIPFI)group with one-year mortality of 45.2%vs.26.7%in IPFI and nIPFI groups respectively(P<0.05).Conclusions IPFI is prevalent after LT in southern China.And aspergillosis is the most common pathogen and Candida comes the next.The median occurring time for aspergillosis is 6 months after LT.Candida infection occurs earlier at airway anastomosis.A higher incidence of invasive fungal disease(IFD)associated with a lower survival indicates that IPFI has a substantial mortality among recipients after LT.Prophylactic agents should be optimized based upon an epidemiologically likely pathogen.
作者
巨春蓉
练巧燕
陈奥
徐鑫
韦兵
曹庆东
林万里
黄丹霞
李时悦
何建行
Ju Chunrong;Lian Qiaoyan;Chen Ao;Xu xin;Wei Bing;Cao Qingdong;Lin Wanli;Huang Danxia;Li Shiyue;He Jianxing(Department of Respiratory Medicine,First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Health,Guangzhou 510120,China;Department of Organ Transplantation,First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Health,Guangzhou 510120,China;Department of Thoracic Surgery,First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Health,Guangzhou 510120,China;Department of Thoracic Surgery,Fifth Affiliated Hospital of Zhongshan Medical University,Zhuhai 519100,China;Department of Thoracic Surgery,People's Hospital of Gaozhou Province,Gaozhou 525200,China)
出处
《中华器官移植杂志》
CAS
2021年第9期539-543,共5页
Chinese Journal of Organ Transplantation
基金
广东省钟南山医学基金会(ZNSA-2020013)
2019年度广州呼吸健康研究院/广医一院国家临床研究中心临床自主探索项目(2019GIRHZ04)。
关键词
肺移植
侵袭性肺部真菌感染
曲霉
Lung transplantation
Invasive pulmonary fungal infection
Aspergillus
