CAJ | 학술논문

背景：肺部感染是肾移植后的主要感染并发症，其发病时间和发病率可能与肾移植后常规口服预防感染药物有关。 　　目的：分析应用静脉甲泼尼龙替代口服醋酸泼尼松治疗肾移植后重症肺部感染效果。 　　方法：回顾分析58例肾移植后重症肺部感染患者的临床资料。首先根据患者发病特点及肺部CT表现，应用广谱抗生素及抗真菌治疗，随后在得到病原学及真菌、病毒检测结果后进行针对性治疗，停用或调整免疫抑制剂用量和组合方案。58例患者中30例延续口服醋酸泼尼松，28例应用注射用甲泼尼龙琥珀酸钠替代口服醋酸泼尼松治疗。积极纠正低氧血症，并予支持治疗、免疫替代治疗。 　　结果与结论：58例患者病原体检测阳性39例(67.2%)，其中单纯细菌性肺炎7例，单纯真菌性肺炎4例，单纯巨细胞病毒感染3例，混合感染25例(多重细菌感染5例，真菌和细菌混合感染17例，真菌、细菌和巨细胞病毒混合感染3例)。甲泼尼龙组患者体温恢复正常时间、患者体温恢复正常时间均短于醋酸泼尼松组(P均<0.05)，肌酐波动范围值小于醋酸泼尼松组(P <0.05)。结果表明应用静脉甲泼尼龙可加快肺部炎症渗出吸收，缩短治疗时间。
배경：폐부감염시신이식후적주요감염병발증，기발병시간화발병솔가능여신이식후상규구복예방감염약물유관。 　　목적：분석응용정맥갑발니룡체대구복작산발니송치료신이식후중증폐부감염효과。 　　방법：회고분석58례신이식후중증폐부감염환자적림상자료。수선근거환자발병특점급폐부CT표현，응용엄보항생소급항진균치료，수후재득도병원학급진균、병독검측결과후진행침대성치료，정용혹조정면역억제제용량화조합방안。58례환자중30례연속구복작산발니송，28례응용주사용갑발니룡호박산납체대구복작산발니송치료。적겁규정저양혈증，병여지지치료、면역체대치료。 　　결과여결론：58례환자병원체검측양성39례(67.2%)，기중단순세균성폐염7례，단순진균성폐염4례，단순거세포병독감염3례，혼합감염25례(다중세균감염5례，진균화세균혼합감염17례，진균、세균화거세포병독혼합감염3례)。갑발니룡조환자체온회복정상시간、환자체온회복정상시간균단우작산발니송조(P균<0.05)，기항파동범위치소우작산발니송조(P <0.05)。결과표명응용정맥갑발니룡가가쾌폐부염증삼출흡수，축단치료시간。
BACKGROUND:Pulmonary infection is the main complication after kidney transplantation, and its onset and morbidity may be related to conventional oral drugs after kidney transplantation. OBJECTIVE:To analyze the effect of methylprednisolone instead of prednisone on severe pulmonary infection after kidney transplantation. METHODS:Clinical data of 58 patients with severe pulmonary infection after kidney transplantation were retrospectively analyzed. First, according to the characteristics of post-onset patients and lung CT findings, broad-spectrum antibiotics and anti-fungal treatment were adopted, and subsequently targeted therapy, that is, withdrawal or adjustment of dosage and combination regimen of immunosuppressive agents, was employed depending on etiology, fungi and virus detection results. Among the 58 patients, 28 patients were injected methylprednisolone, and 30 patients took oral prednisone. Hyoxemia correction, support therapy and immune replacement therapy were applied. RESULTS AND CONCLUSION:Thirty-nine of 58 patients (67.2%) were positive for pathogens, including 7 cases of simple bacterial pneumonia, 4 cases of fungal pneumonia, 3 cases of simple cytomegalovirus infection, and 25 cases of mixed infections (5 cases of multiple bacterial infections, 17 cases of fungal and bacterial co-infections, and 3 cases of fungi, bacteria and cytomegalovirus co-infections). Patients subjected to methylprednisolone treatment spent shorter time to recover their temperature than those undergoing oral prednisone (P<0.05). In addition, creatinine fluctuation range in the methylprednisolone group was less than that in the prednisone group (P<0.05). The results showed that intravenous injection of methylprednisolone may accelerate absorption of inflammatory exudate in the lung and shorten treatment time.