肝移植术后肺曲霉菌感染的诊治

Diagnosis and treatment of lung aspergillosis after liver transplantation.

目的 探讨肝移植术后肺曲霉菌感染的诊治方法。 方法 肝移植术后患者常规进行痰培养 ,应用二性霉素B、伊曲康唑和氟康唑等抗真菌药物治疗 ,回顾性分析了 3例肺部曲霉菌感染患者的诊治经过。 结果 5 4例肝移植患者有 3例发生肺曲霉菌感染 ,治愈 1例 ,死亡 2例。 结论( 1)过度免疫抑制是导致肺曲霉素感染的重要因素。 ( 2 )二性霉素B治疗肺曲霉菌感染有效。 ( 3)为降低二性霉素B的毒副作用和增强疗效 ,治疗方法上可采用渐进性给药、间断性给药、低浓度给药、联合给药 ,真菌培养阴性后用伊曲康唑巩固治疗 2～ 3周。

Objective To assess the diagnosis and treatment of invasive lung aspergillosis after liver transplantation. Methods Routine sputum culture was performed. Itraconazole and fluconazole were used to prevent fungal infection prophylactically. Amphyotericin B was only used on aspergillosis. In 54 patients receiving, liver transplantation, 3 patients with lung aspergillosis were reviewed. Results Of the 3 patients 2 died and 1 recoverd. Conclusions Overimmnosuppression is a main risk factor for aspergillosis. Amphotericin B is still the best choice for the treatment of aspergillosis and its gradual, interrupted, low concentration administration,cooperated with itraconazole can ease the side effects.