肾移植术后肺部感染的临床表现及病原学分析

Retrospective Analysis on Clinical Features and Pathogen Kinds of Pulmonary Infection after Kidney Transplantation

目的总结肾移植术后肺部感染的临床表现、病原学及救治措施,以提高其治愈率。方法对四川大学华西医院50例次肾移植术后肺部感染住院患者的病历资料进行回顾性分析。结果共收集42例(50例)次肾移植肺部感染患者,痰培养检出病原体38例次(76%),未检出12例次,其中细菌感染17例次(44.7%),真菌感染7例次(18.4%),巨细胞病毒感染19例次(38%),支原体感染6例次(12%),混合感染10例次(20%)。肺部感染发生在肾移植术后1个月以内者3例(7%),1～6个月者16例(38%),6个月以后者23例(55%)。50例次感染患者中48例次经积极治疗抢救后好转出院,有2例患者死亡。结论肾移植术后肺部感染患者的病原体与肾移植术后时间有一定的规律性。对于肾移植术后肺部感染,救治成功的关键是早期病原体及CT检查,及时给予综合治疗措施,包括经验性抗生素治疗措施,及时调整免疫抑制剂方案,加强全身支持。

Objective To analyze the clinical features of pulmonary infection after kidney transplantation. Methods the clinical manifenctions and related laboratory results of 50 inpatients treated from January 2010 to December 2010 were reviewed retrospectively. Results In all, 42 renal transplant recipients with pulmonary infection were collected in our study. The pathogens identified in 38 episodes by sputum analysis indicated that 17 （44.7%） were bacteria, 7 （18.4%） were fungus, 19 （38%） were CMV infection, 6 （12%） were mycoplasma infection, and 10 （20%） were complicated infection. The pulmonary infection occurred 1 month after kidney transplantation in 3 patients （7%）, 1-6 months in 16 （38%）, and more than 6 months in 23 （55%）. Among 50 patients, 48 were cured after treatment timely and the other 2 died. Conclusions The occurred time relates with the pathogens in pulmonary infection following kidney transplantation. The key of successful treatment is early detection of pathogens, CT scan, systemic treatment, timely antimicrobial therapy, adjustment of immunosuppressive agents, and enhancing systemic support.