肝移植术后侵袭性曲菌病的防治

Prevention and treatment of invasive aspergillosis following liver transplantation

目的探讨原位肝移植术后侵袭性曲菌病的防治。方法回顾性分析2000年1月至2005年1月完成的576例原位肝移植的临床资料,总结术后侵袭性曲菌病的预防和治疗经验。结果9例患者术后并发侵袭性曲菌病,发病率为1.74%(9/576),首发感染部位为肺部8例,中枢神经系统感染1例。6例患者停用免疫抑制治疗,3例患者将他克莫司(FK506)或CsA降低到最低有效血药浓度。6例患者选用两性霉素B脂质体(其中1例先试用氟康唑)、3例首选伊曲康唑进行治疗。5例肺部感染患者痊愈,2例因肺部感染无法控制死亡,2例因并发多器官曲霉菌感染死亡。结论早发现并及时调整免疫抑制治疗方案,早期、足量和足程使用抗真菌药物,积极行手术治疗是降低肝移植术后侵袭性曲菌病发病率和病死率的根本措施。

Objective To explore the prevention and treatment of invasive aspergillosis following orthotopic liver transplantation. Methods The clinical data of 9 cases with invasive aspergillosis after orthotopic liver transplantation between January 2000 and January 2005 were analyzed retrospectively. Results The incidence rate of invasive aspergillosis was 1.74% （9/576）. 8 cases were pulmonary aspergillosis and 1 case was cerebral aspergillosis. 6 patients were deprived of immunosuppression treatment and 3 patients received tacrolimus and cyclosporine with their blood levels kept in the low therapeutic range. Liposomal amphotericin B （AmBisome） was given in 6 cases and itraconazole in 3 cases for the treatment of invasive aspergillosis. 5 patients were cured and 2 patients developed multiorgan aspergillosis infection and died. Conclusions Rapid diagnosis,appropriate modification of immunosuppressive therapy, timely administration of antifungal agents, surgical interventions are the fundamental treatments for the disease.