肺移植术后曲霉菌感染的分析

Aspergillus infection in lung transplant recipients:risk factors,treatment and outcomes

目的研究肺移植术后患者发生曲霉菌感染的发病率和发病过程,探讨早期预防、检测和治疗曲霉菌感染的经验。方法回顾性分析2003年1月—2007年5月进行的15例单肺或双肺移植患者的临床资料,总结肺移植术后患者发生曲霉菌感染的发病率和发病过程以及诊疗经验。结果15例肺移植患者中,有5例(33%)患者在肺移植术后发生曲霉菌感染,其中气道内曲霉菌寄生、孤立性曲霉菌性支气管炎和侵袭性曲霉菌性肺炎这三种类型的发生率分别为13%、6%和13%。多数患者在术后1年内确诊。结论肺移植患者术后早期较容易发生曲霉菌感染。肺移植患者术后进行早期诊断和早期治疗对防治肺曲霉菌感染有着积极的作用,但是术前和术后早期使用抗真菌药物进行预防的效果还不确切。

Objective To define the incidence and natural history of Aspergillus colonization and infection in lung transplant recipients, and to assess the impact of prophylaxis, surveillance, and therapy on the incidence and outcome of the disease. Methods Retrospective review of 15 consecutive single or bilateral lung transplantations performed at a single institution, and review of the published literature. Results Airway colonization, isolated tracheobronchitis, and invasive pneumonia due to Aspergillus species occurred in 13% , 6% , and 13% of our series greater than 50% of all diagnoses were made in the first 12 months after transplantation in our series. Conclusion Lung transplant recipients are more prone to Aspergillus in early postoperative. The role of antifungal therapy in Aspergillus airway colonization in lung transplant recipients is unclear. A strategy of early diagnosis by scheduled screening bronchoscopy and early treatment for Aspergillus infection in lung transplant recipients is recommended.