CAJ | 학술논문

目的探讨肾移植后间质性肺炎的临床病程规律、治疗原则及影响转归的主要因素.方法回顾性分析2006年11月至2013年12月间诊治的30例肾移植后早期间质性肺炎患者的临床资料,对其临床表现、病程进展规律、治疗措施及临床转归进行分析.结果 30例患者中有29例于肾移植后2～6个月内发病,其病程进展具有较一致的规律性,整个病程时间为(34.9±7.5)d,通过每周肺部CT检查,发现起病到病程高峰的时间为(14.8±1.9)d,病程达到高峰后一般维持(7.3±3.6)d,即会出现明显的病程好转.若病程高峰时的肺部CT表现严重,且维持时间长而未出现病程好转,则往往预后较差.病程恢复时间为(13.1±3.7)d.治疗上通过使用皮质激素、抗生素和抗真菌药物进行优化调整,结合营养支持、提高免疫力以及大幅减量或停用免疫抑制剂等措施,病程高峰期胸部CT表现程度为较轻及中度的23例患者均治愈出院,胸部CT表现较重的7例患者中3例治愈,4例死亡.结论肾移植后早期间质性肺炎具有比较规律的病程进展特点.治疗上,对目前的大多数文献报道的治疗方案,包括对于甲泼尼龙的使用、抗生素的使用、抗真菌药物的使用、营养支持和免疫抑制剂的使用等方面进行进一步的优化调整,在避免过度医疗的情况下可取得良好的治疗效果.
목적 탐토신이식후간질성폐염적림상병정규률、치료원칙급영향전귀적주요인소.방법 회고성분석2006년11월지2013년12월간진치적30례신이식후조기간질성폐염환자적림상자료,대기림상표현、병정진전규률、치료조시급림상전귀진행분석.결과 30례환자중유29례우신이식후2～6개월내발병,기병정진전구유교일치적규률성,정개병정시간위(34.9±7.5)d,통과매주폐부CT검사,발현기병도병정고봉적시간위(14.8±1.9)d,병정체도고봉후일반유지(7.3±3.6)d,즉회출현명현적병정호전.약병정고봉시적폐부CT표현엄중,차유지시간장이미출현병정호전,칙왕왕예후교차.병정회복시간위(13.1±3.7)d.치료상통과사용피질격소、항생소화항진균약물진행우화조정,결합영양지지、제고면역력이급대폭감량혹정용면역억제제등조시,병정고봉기흉부CT표현정도위교경급중도적23례환자균치유출원,흉부CT표현교중적7례환자중3례치유,4례사망.결론 신이식후조기간질성폐염구유비교규률적병정진전특점.치료상,대목전적대다수문헌보도적치료방안,포괄대우갑발니룡적사용、항생소적사용、항진균약물적사용、영양지지화면역억제제적사용등방면진행진일보적우화조정,재피면과도의료적정황하가취득량호적치료효과.
Objective To investigate the clinical pattern,therapeutic principle and influencing factors of interstitial pneumonia in renal allograft recipients.Method The general information,clinical manifestation,treatment and outcomes of 30 recipients with interstitial pneumonia after renal transplantation from Nov.2006 to Dec.2013 were analyzed retrospectively.Result Twenty-nine of 30 patients developed interstitial pneumonia between 2 to 6 months post-transplant.The total course of the pneumonia lasted for 34.9 ± 7.5 days on average.Chest CT scans were used to monitor severity of interstitial pneumonia each week.The mean duration between the onset to the fastigium of pneumonitis was approximately 14.8 ± 1.9 days.The mean duration of the fastigium lasted for 7.3 ±3.6 days,after that the patients usually started to recover.Deteriorated chest CT scan findings and long terms of the fastigium usually indicated poor outcomes.The mean duration of the recovery period was 13.1 ± 3.7 days.After adjusted administration of methylprednisolone,antibiotics,antifungal agents,nutritional support as well as immunosuppressive drugs,23 patients with mild and moderate pneumonia by the chest CT scans were cured and discharged.However,4 of the 7 patients with severe pneumonia by the chest CT scans died.Conclusion The progression of interstitial pneumonia after renal transplantation is characterized by a more consistent regularity.After adjusted administration of methylprednisolone,antibiotics,antifungal agents,nutritional support as well as immunosuppressive drugs,renal allograft recipients with interstitial pneumonia could obtain a good therapeutic effect without over-treatment.