器官移植术后并发急性间质性肺疾病31例临床分析

Clinical analysis of 31 patients with acute interstitial lung diseases after organ transplantion

目的总结器官移植术后并发急性间质性肺疾病的临床特点并探讨其诊断与治疗。方法回顾性分析近3年上海交通大学附属第一人民医院收治的31例器官移植术后并发急性间质性肺疾病患者的临床姿料,对其一般情况、治疗措施及临床转归进行分析。结果病因诊断为巨细胞病毒感染22例,肺孢子菌感染2例,原因不明7例。21例治愈出院,包括2例肺孢子菌感染者,10例死亡,6例为巨细胞病毒感染,4例为病原菌不明,主要死因为急性呼吸窘迫综合征。结论巨细胞病毒感染和肺孢子菌感染是器官移植术后并发急性间质性肺疾病的主要病因,早期诊断和治疗可以改善患者的预后。

Objective To summarize the characteristics of acute interstitial lung diseases after organ transplantation and to investigate the diagnosis and treatment. Methods The clinical data, general information, treatment and outcomes of 31 recipients with acute interstitial lung diseases after organ transplantation were retrospectively analyzed; the patients were treated in our hospital during the recent 3 years. Results Twenty-two of the 31 patients had cytomegalovirus （CMV） infection, 2 had Pneumocystis jirovecii infection, and 7 had unknown reasons. Twenty-one patients recovered （including 2 with Pneumocystis jirovecii） and were discharged. Ten patients died （including 6 with infection, 4 with unknown pathogens）, with acute respiratory distress syndrome being the main cause. Conclusion CMV and Pneumocystis jirovecii seem to be the main pathogens of acute interstitial lung diseases in organ transplantation recipients. Early diagnosis and treatment can improve the prognosis. （Shanghai Med J, 2009, 32： 869-871）