CAJ | 학술논문

背景:肾移植后感染已成为肾移植患者移植肾失功和死亡的主要原因之一,肾移植后感染目前尚无统一、标准的治疗方案.目的:探讨肾移植患者后感染临床特点及诊治方法,提高肾移植后感染的治愈率.设计、时间及地点:回顾性病例分析,于2006-02/2008-02在昆明医学院第一附属医院器官移植中心完成.对象:84例肾移植患者中18例移植后的感染者.方法:所有患者入院后均行胸部X射线检查,X射线检查未提示肺部明显病变或肺部感染症状及体征明显者行肺部CT检查.行病原学检测,包括血、尿、痰,鼻拭子、咽拭子培养,痰涂片+培养查真菌,抽血查CMV、EB-DNA及支原体,痰查抗酸杆菌.对所有肺部感染患者均采用综合治疗,即抗菌素+抗病毒药物+抗真菌药物,根据患者病情、血常规淋巴细胞绝对值及CD4+T细胞绝对值计数调整免疫抑制剂用量对患者感染发生时间、临床症状、辅助检查及诊断和治疗策略进行分析.主要观察指标:①感染发生时间及症状.②影像学表现和病原学检测结果.③抗生素的选用和免疫抑制剂调整.结果:18例患者中,11例(61.2%)为尸体供肾肾移植患者.12例(66.7%)发生于移植后3月内,15例(83.3%)发生于移植后6月内.14例(77.8%)以发热为主要症状,呼吸道感染15例(83.3%),其中13(72.2%)例为肺部感染.6例病原学检查提示真菌感染,且以念珠菌为主.3例(16.7%)死亡其中2例合并巨细胞病毒感染,均为混合性感染.结论:肾移植后感染患者病原体呈多样性,但以细菌、真菌和病毒为主.重症肺炎合并CMV感染提示预后不良,真菌和病毒感染在肾移植后感染患者中应引起足够重视.治疗以综合降阶梯治疗为主,及时调整免疫抑制剂治疗方案甚至停用免疫抑制剂是治疗的关键之一.
배경:신이식후감염이성위신이식환자이식신실공화사망적주요원인지일,신이식후감염목전상무통일、표준적치료방안.목적:탐토신이식환자후감염림상특점급진치방법,제고신이식후감염적치유솔.설계、시간급지점:회고성병례분석,우2006-02/2008-02재곤명의학원제일부속의원기관이식중심완성.대상:84례신이식환자중18례이식후적감염자.방법:소유환자입원후균행흉부X사선검사,X사선검사미제시폐부명현병변혹폐부감염증상급체정명현자행폐부CT검사.행병원학검측,포괄혈、뇨、담,비식자、인식자배양,담도편+배양사진균,추혈사CMV、EB-DNA급지원체,담사항산간균.대소유폐부감염환자균채용종합치료,즉항균소+항병독약물+항진균약물,근거환자병정、혈상규림파세포절대치급CD4+T세포절대치계수조정면역억제제용량대환자감염발생시간、림상증상、보조검사급진단화치료책략진행분석.주요관찰지표:①감염발생시간급증상.②영상학표현화병원학검측결과.③항생소적선용화면역억제제조정.결과:18례환자중,11례(61.2%)위시체공신신이식환자.12례(66.7%)발생우이식후3월내,15례(83.3%)발생우이식후6월내.14례(77.8%)이발열위주요증상,호흡도감염15례(83.3%),기중13(72.2%)례위폐부감염.6례병원학검사제시진균감염,차이념주균위주.3례(16.7%)사망기중2례합병거세포병독감염,균위혼합성감염.결론:신이식후감염환자병원체정다양성,단이세균、진균화병독위주.중증폐염합병CMV감염제시예후불량,진균화병독감염재신이식후감염환자중응인기족구중시.치료이종합강계제치료위주,급시조정면역억제제치료방안심지정용면역억제제시치료적관건지일.
BACKGROUND: Infection following kidney transplantation has become one of the main reasons for graft failure and death of allograft recipients. However, there is not a standard therapeutic scheme for infection following kidney transplantation. OBJECTIVE: To investigate the clinical features and treatment measures of infection, additionally, to increase the cure rate of infection following kidney transplantation.DESIGN, TIME AND SETTING: A retrospectively analysis was performed at the Organ Transplantation Center, the First Affiliated Hospital of Kunming Medical College from February 2006 to February 2008.PARTClPANTS: Eighteen cases of infections in 84 kidney allograft recipients.METHODS: All cases were checked by chest X-ray. Patients who had no significant lung infection symptoms or obvious signs received lung CT scan. Pathogen detection was performed, including hemoculture, urine culture, sputum culture, nose swabs culture, throat swab culture, checking clinically important cytomegalovirus (CMV), EB-DNA and mycoplasma in blood, acid-fast bacilli and eumycete culture in sputum. All cases of pulmonary infection underwent a comprehensive treatment-antiviral drugs, antibiotics and antifungal. Depending on the individual condition and absolute values of lymphocytes and CD4+T cells, the immunosuppressant was adjusted individually. The occurrence time, clinical symptom, auxiliary examination and treatment strategies were analyzed.MAIN OUTCOME MEASURES: The occurrence time of infection and clinical symptoms; imaging manifestation and results of pathogenic detection; selection of antibiotics and immunosuppressant adjustment.RESULTS: Among 18 cases, 11 cases (61.2%) were deceased-donor kidney transplant recipients. Inflection following kidney transplantation occurred in 12 cases (66.7%) within 3 months, and increased to 15 cases (83.3%) within 3-6 months. Of the 18 infection cases, 14 cases (77.8%) had a main symptom of fever. There were 15 cases (83.3%) of respiratory tract infection, including 13 cases (72.2%) of pulmonary infection. Fungal cultivation, especially Monilia, was positive in 6 cases. Three out of the 18 cases (16.7%) died, two of whom had CMV infection. Mixed infection occurred in all cases.CONCLUSION: Infected patients following kidney transplantation present with diversity pathogens, which are dominated by bacteria, fungus and virus. Severe pneumonia combined with CMV infection demonstrates that poor prognosis, fungal and virus infection following kidney transplantation should be given more attention. Combined de-escalation therapy is the main method, and timely adjustment and even discontinuance of immunosupprassive agents is one of the key points in the treatment of infection following kidney transplantation