CAJ | 학술논문

目的：探讨肾移植受者术后侵袭性肺曲霉（ IPA）感染的诊治。方法回顾性分析济南军区总医院泌尿外科2008年7月至2013年5月肾移植术后15例IPA感染受者的临床资料。结果15例受者均为首次肾移植，均为肾移植术后半年内发生IPA感染，最早于术后16 d发现。经半乳甘露聚糖试验（ GM试验）检出IPA 9例，肺部CT检查检出4例，血培养检出3例，痰培养检出5例。9例合并CMV或细菌感染，2例合并假丝酵母菌属感染，4例为单纯性IPA感染。13例IPA感染受者给予伏立康唑注射液治疗（3例为确诊病例，10例为临床诊断病例），其中2例合并或序贯给予米卡芬净；另2例临床诊断病例给予伊曲康唑注射液治疗。共有9例受者治愈，6例死亡。结论 GM试验、肺部CT检查等对肾移植术后IPA感染具有一定的诊断价值，结合临床表现，能够较早诊断IPA感染，有助于及时进行早期治疗，提高患者生存率。
목적：탐토신이식수자술후침습성폐곡매（ IPA）감염적진치。방법회고성분석제남군구총의원비뇨외과2008년7월지2013년5월신이식술후15례IPA감염수자적림상자료。결과15례수자균위수차신이식，균위신이식술후반년내발생IPA감염，최조우술후16 d발현。경반유감로취당시험（ GM시험）검출IPA 9례，폐부CT검사검출4례，혈배양검출3례，담배양검출5례。9례합병CMV혹세균감염，2례합병가사효모균속감염，4례위단순성IPA감염。13례IPA감염수자급여복립강서주사액치료（3례위학진병례，10례위림상진단병례），기중2례합병혹서관급여미잡분정；령2례림상진단병례급여이곡강서주사액치료。공유9례수자치유，6례사망。결론 GM시험、폐부CT검사등대신이식술후IPA감염구유일정적진단개치，결합림상표현，능구교조진단IPA감염，유조우급시진행조기치료，제고환자생존솔。
Objective To observe and explore the diagnosis and treatment of invasive pulmonary aspergillosis ( IPA) after renal transplantation .Method Fifteen patients in Jinan Military General Hospital diagnosed with IPA after renal transplantation were retrospectively analyzed .Results Among 15 patients, 9 were diagnosed by galactomannan test (GM test), 4 by CT, 3 by blood culture, and 5 by sputum samples.In those patients, 9 were supervened by cytomegalovirus or bacterial infection, 2 were done by Candida infection , and 4 underwent exclusively IPA.After diagnosed, intravenous voriconazole was given immediately for 13 patients, of whom 2 were given micafungin concurrently or sequentially .Itraconazole injection was given for 2 patients.In this study, 9 patients were cured, and 6 died.Conclusion Both GM test and CT play important roles in the diagnosis of IPA after renal transplantation .Early diagnosis and treatment for IPA after renal transplantation are very important to improve the survival rate of the patients .