肾脏病患者免疫抑制剂相关的肺部感染49例报告及文献复习

Clinical characteristics about immunosuppressant related pneumocystis carinii pneumonia in kidney disease

目的:分析用免疫抑制剂治疗的肾脏病患者并发肺部感染的病因及临床特点。方法:回顾性分析温州医科大学附属第一医院2006年6月至2013年8月使用免疫抑制剂伴发肺部感染的49例肾脏病患者的临床资料和免疫抑制剂使用方案。结果:本组20例为肾移植患者,29例为非肾移植肾脏病患者。基础疾病为膜性肾病8例,血管炎相关肾病3例,IgA肾病4例,狼疮性肾炎7例,紫癜性肾炎1例,其他慢性肾小球肾炎26例。患者以间质性肺炎为主要临床特征,表现为呼吸费力、咳嗽、发热。卡氏肺囊虫肺炎(PCP)共12例,其中肾移植患者9例,非肾移植肾脏病患者3例。结论:PCP患者无特异临床表现,且易出现呼吸衰竭,较易误诊。低白蛋白血症是PCP感染的独立危险因素之一,应对PCP提高警惕,尽早给予足量的复方磺胺甲恶唑并及时调整免疫抑制剂用量,必要时输注人血白蛋白及血浆,以提高PCP的治愈率。

Objective： To analyze etiology and clinical characteristics of pneumocystis carinii pneumonia in kidney disease patients who accepted immunosuppressive therapy. Methods： Retrospective analyse clinical datas and immunosuppressive schemes of 49 cases kidney disease patients, accompanied with lung infection during June, 2006 to August, 2013 from the First Affiliated Hospital of Wenzhou Medical University. Results： Kidney transplant patients were 20 cases, non-kidney transplant patients were 29 cases. Membranous nephropa- thy patients were 8 cases, vasculitis associated nephropathy patients were 3 cases, IgA nephropathy patients were 4 cases, lupus nephritis patients were 7 cases, purpura nephritis was 1 case, the other chronic glomerulonephritis patients were 26 cases. Interstitial pneumonia was the main clinical feature in patients, who mainly represent with breathing trouble, cough and fever. 12 cases of pneumocystis carinii pneumonia （PCP）, including 9 cases of kidney transplant patients, 3 cases of non-kidney transplant patients. Conclusion： The high incidence of lung in- fection is observed in kidney disease patients who accepted immunosuppressive therapy in the first year （53.0%）, especially in patients of renal transplantation in 6 months. The patients of PCP have no specific clinical manifestations, and are prone to respiratory failure, and hypoalburninemia is one of the independent risk factors for PCP, we should pay attention to PCP, give a sufficient amount of sulfamethoxazole, use plasma and albumin if necessary, and adiust the dosage of immunosuppressant in time.