肾移植术后并发卡氏肺孢子虫病的诊断和治疗

Diagnosis and treatment of pneumocystosis after renal transplantation

目的 探讨肾移植术后并发卡氏肺孢子虫病的早期诊断及治疗。方法 对 6例肾移植术后并发卡氏肺孢子虫病的有关临床资料进行分析和总结。结果 6例患者确诊为卡氏肺孢子虫病后给予复方磺胺甲卟恶唑 (SMZ 6 0～ 70mg·kg-1·d-1,TMP 12～ 14mg·kg-1·d-1,分 2～ 4次给药 )治疗 3周 ,并调整免疫抑制方案及对症治疗 ,除 1例患者因放弃治疗死亡外 ,其余 5例均治愈 ,移植肾功能正常。结论 卡氏肺孢子虫病的确诊有赖于肺组织活检找到病原体 ,治疗首选复方磺胺甲卟恶唑 ,并适当减少免疫抑制剂用量。

Objective To investigate the early diagnosis and treatment of pneumocystosis after renal transplantation. Methods The clinical data of 6 cases of renal transplant recipients from 2000-2001 who developed pneumocystosis were discussed. Results Six patients were diagnosed as having pneumocystosis and subjected to the treatment of SMZ_ CO (SMZ 60-70 mg/kg daily, TMP 12-14 mg/kg daily) for 3 weeks. Immunosuppressive regimene was regulated. Except one case died due to abandonment of treatment, the remaining 5 cases were cured and had normal renal function. Conclusion The diagnosis of pneumocystosis was established by visualization of pathogen in bronchialveolar lavage (BAL) samples. SMZ_ CO is still the most commonly used drug for pneumocystosis at present and administration for individual is important because of its renal toxicity. The dosage of immunosuppressive agent for each patient with pneumocystosis must be adjusted.