肾移植后并发肺炎17例

Diagnosis and treatments of pneumonia in 17 patients following kidney transplantation

背景：肺炎是肾移植后患者常见的并发症和主要的死亡原因.目的：探讨肾移植后患者并发肺炎的临床特点及诊治方法.方法：收集2008-05/2010-12期间住院治疗的17例肾移植后并发肺炎患者的临床资料进行回顾性分析.结果与结论：肺炎发生于肾移植后6个月以内的有12例（70.6%）,6个月～1年1例（5.9%）,1年以上4例（23.5%）.其中14例（82.4%）获得病原体检测结果,包括革兰阴性杆菌8例（47.1%）,巨细胞病毒7例（41.2%）,革兰阳性球菌6例（35.3%）,卡氏肺孢子虫3例（17.6%）,结核杆菌3例（17.6%）,念珠菌3例（17.6%）,军团菌1例（5.9%）.5例为单一病原体感染,9例为混合感染.存活9例（52.9%）,死亡8例（47.1%）.肾移植术后并发肺炎多数为混合感染,纤维支气管镜检查是寻找病原体的重要手段,除合理的抗感染治疗外,综合治疗及不断调整免疫抑制剂的方案同样重要.

BACKGROUND： Pneumonia is the common complication and main cause of death after kidney transplantation. OBJECTIVE： To investigate the clinical features, diagnosis and treatment methods of pneumonia in kidney transplant patients. METHODS： Clinical data of 17 cases of pneumonia who received renal transplantation from May 2008 to December 2010 were retrospectively analyzed. RESULTS AND CONCLUSION： Among 17 patients, 12 patients （70.6%） and 1 patient （5.9%） developed pneumonia within 6 months and 6-12 months respectively after renal transplantation, and 4（23.5%） patients developed pneumonia 12 months later. 14（82.4%） patients obtained pathogenic results, including gram negative bacillus （8 cases, 47.1%）, cytomegalovirus （7 cases, 41.2%）, gram positive coccus （6 cases, 35.3%）, pneumocystis carinii （3 cases, 17.6%）, tuberculosis （3 cases, 17.6%）, candidiasis albicans （3 cases, 17.6%）, legionella （1 case, 5.9%）. Single causative organism could be found in only 5 cases and multiple etiologies were found in 9 cases. No definitive cause could be found in 3 cases. 9 cases （52.9%） survived and 8 cases （47.1%） died. Most of pneumonia in renal transplant recipients can be attributed to multiple organisms. Bronchoscopy is important in the finding of microorganisms. Beside proper antibiotics, combined therapy and adjustment of immunosuppressants are of equal importance.