51例肾移植患者应用免疫抑制疗法并发肺炎的回顾性分析

Pneumonia secondary to immunosuppressant regimens in renal transplant patients:a retrospective analysis of 51 cases

目的:分析肾移植术后患者应用免疫抑制疗法并发肺炎的病因及临床特点。方法:收集1999年1月至2004年12月,北京4所医院收治的51例肾移植术后应用免疫抑制疗法并发肺炎患者的临床资料。肾移植术后患者均口服环孢素90～400mg/d,吗替麦考酚酯500～1500mg/d,泼尼松5～30mg/d,治疗3个月后逐渐减至维持剂量(环孢素血浓度100～200ng/ml)。分析肾移植术后并发肺炎患者的临床表现、病原学特点以及脏器功能不全的发生率和病死率。结果:51例患者以间质性肺炎为主要临床特征,表现为发热、干咳、胸部X线平片示片状模糊阴影。致病的病原体中细菌感染17例(33.33%),病毒感染7例(13.73%),卡氏肺孢子虫感染4例(7.84%),真菌感染1例(1.96%),病因不明8例(15.69%),混合感染14例(27.45%)。细菌培养显示以革兰阴性菌为多,占总菌株数的60%,革兰阳性菌占40%。并发成人型呼吸窘迫综合征11例(21.57%),弥散性血管内凝血4例(7.84%)。11例死亡(21.57!),治愈40例(78.43!)。结论:肺炎是肾移植患者应用免疫抑制疗法的严重并发症,早期诊断,予以抗感染治疗,并及时调整免疫抑制剂治疗方案,有利于减少肺炎的发生和提高治愈率。

Objective： To analyze the etiology and clinical characteristics of pneumonia secondary to irnmunosuppressant regimens in renal transplant patients. Methods.. The clinical data of 51 renal transplant patients with pneumonia receiving irnmunosuppressant regimens from four hospitals in Beijing between January 1999 and December 2004 were collected. The renal transplant patients were administered orally with cyclosporine 90-400 mg daily, mycophenolate mofetil 500-1 500 mg daily, and prednisone 5-30 mg daily for 3 months, and then the dosage was decreased to maintenance dose （Blood cyclosporine concentration was maintained in 100-200 ng/ml）. The etiology, clinical manifestations, incidence of organs dysfunction and death to the renal transplant patients accompanied with pneumonia were analyzed. Results： The principal clinical characteristics of the 15 patients were interstitial pneumonia. The clinical manifestations were fever and cough. A chest X-ray revealed a blurred shadow. Of 51 cases, 17 cases （33.33%） were bacterial infections, 7 cases （13.73%） were virus infections, 4 cases （7.84%） were pulmonary carinii infection, 1 case （1.96%） was fungal infections, 8 cases （15.69%） were unknown and 14 cases （27.45%） were mixed infections. Bacterial culture revealed Gram negative bacteria constituted the majority. Of total bacterial strain count, Gram negative bacteria accounted for 60% and Gram positive bacteria accounted for 40%. Adult respiratory distress syndrome and disseminated intravascular coagulation occurred in 11 cases （21.57%） and 4 cases （7.84%）, respectively. Of all patients, 11 cases （21.57%） died, and 40 cases （78.43%） were cured. Conclusion： Pneumonia is a severe complication in renal transplant patients receiving immunosuppressant regimens. Early diagnosis, anti-infective therapy, and adjustment ofimmunosuppressant regimens benefit to decrease the occurrence of pneumonia and to increase the cure rate.