肾移植术后不同时期肺炎的临床比较

Clinical features of pulmonary infection at different stages after renal transplantation

目的探讨肾移植后不同时期肺部感染的临床表现、病原学特点和治疗策略,以提高肾移植后肺部感染患者的存活率。方法回顾性分析2003年1月—2008年7月于我院因肺部感染住院患者61例。按照肺部感染发病距肾移植手术时间将患者分为两组:近期感染组(术后≤12个月);远期感染组(术后>12个月)。分析并比较两组患者在病原学、临床表现、治疗、病程和转归等方面的特点。结果43例近期感染病例多表现为发热、胸闷气促,影像学表现为两肺弥漫间质性改变,病原体以巨细胞病毒和真菌较多见,常需抗病毒、真菌、细菌综合治疗,并及早使用机械辅助通气。18例远期肺部感染病例有肺部体征和咳嗽、咳痰症状,影像学表现单侧局限改变,但合并心脏、胃肠道并发症较多见,有并发症者病死率较高。结论肺部感染是肾移植术后的严重并发症和主要死亡原因之一。肾移植术后远、近期发生的肺部感染在病因、临床特点及转归等方面各有其特点。据此,早期积极取得病原学证据、针对病因施治、预防并发症、积极治疗合并症可能有助于提高肾移植患者的预后。

Objective To investigate the clinical features and prognosis of pulmonary infection at different stages after renal transplantation. Methods Medical records of 61 patients with pulmonary infection after renal transplantation from January 2003 to July 2008 in our hospital were reviewed in this retrospective study. According to stages of infection onset, we divided all patients into two groups, early onset group （43/61, 70.5%, ≤12 months after transplantation） and late onset group （18/61, 29.5%, 〉12 months after transplantation）. Clinical manifestations and prognosis were compared between the two groups. Results In the early onset group, the radiographic manifestation suggested diffuse interstitial changes of bilateral lungs. Combination of anti-infective therapy and early mechanical ventilation was preferred. While in the late onset group, unilateral pulmonary lesions were seen in most cases. More patients showed cardiac and gastrointestinal complications in this group, the mortality of which was much higher. Conclusions Pulmonary infection is a major complication of renal transplantation. The etiology, clinical characteristics and prognosis of infection varies with the stage after transplantation. Effective preventive and therapeutic measures should be applied more vigorously in patients with pulmonary infection, especially early onset ones.