肝移植术后间质性肺炎的诊治经验

The diagnosis and treatment of interstitial pneumonia after liver transplantation

目的总结诊治肝移植患者术后间质性肺炎的经验。方法回顾分析2001年4月至2009年6月期间诊治的8例同种异体肝移植术后间质性肺炎病人的临床资料。结果8例肝移植术后间质性肺炎患者的发病时间为术后17～117 d,平均84 d,其中7例发生于术后2～4个月。8例均有发热,其中抗巨细胞病毒(CMV)特异性抗体CMV-IgM阳性及CMV-DNA阳性4例,胸部CT均有明显间质性肺炎表现。经调整抗排斥药物用量、使用更昔洛韦及呼吸支持治疗后,4例患者临床症状明显好转,胸部CT恢复正常;4例患者病情进展,继发细菌或真菌感染,死于呼吸衰竭。结论肝移植后间质性肺炎临床表现无特异性,病死率高,应及时予胸部CT检查,同时加强病原体的监测。确诊后予调整免疫抑制剂用量、早期抗病毒治疗及对症支持治疗,以提高治愈率。

Objective To review diagnosis and treatment experience of interstitial pneumonia after liver transplantation. Methods The clinical data of 8 patients with interstitial pneumonia from 765 patients underwent liver transplantation in our hospital from April 2001 to June 2009 were analyzed retrospectively. Results Interstitial pneumonia occurred 17 - 117 d after operation （ mean 84 d）, 7 of these occurred from 2 to 4 months after operation. All patients developed high fever and blood antibody of eytomegalovirus （CMV） and CMV-DNA were detected in 4 patients with interstitial pneumonia. CT scan of chest revealed ground-glass-like changes in all 8 patients. After immunosuppressive drugs reduction, oral administration of gancielovir as well as respiratory support, 4 patients were recovered and 4 died of respiratory failure. Conclusions Interstitial pneumonia after liver transplantation is lack of specific symptoms but with high mortality. CT scan of chest should be performed immediately and frequently to monitor infection. Reduction of immunosuppressive medicine dosage, early antiviral therapy of CMV infection and supportive care are very important in treating interstitial pneumonia.