CAJ | 학술논문

目的探讨肾移植后肺毛霉病的临床特点、影像学表现、诊断和治疗方法.方法收集经肺组织活检病理证实的肾移植后肺毛霉病3例的相关资料,其中男性2例,女性1例,年龄为39～54岁.均因“尿毒症”接受肾移植,1例合并糖尿病,分别于肾移植后6个月、2年及6年发病.症状有发热、咳嗽、痰中带血及胸痛等.CT影像学表现,2例早期为多发不规则块状影,1例早期为双肺弥漫性浸润影;均较快进展为多发厚壁空洞;1例伴胸水.3例均经CT引导下经皮肺穿刺病理检查确诊.结果 3例中,例1采用伊曲康唑治疗1年,治愈,停药8个月后复发;例2伊曲康唑治疗21 d,显效,因移植肾发生排斥反应,加强免疫抑制后毛霉播散,死亡;例3经伊曲康唑治疗,显效,仍在随防中.结论肾移植受者并发肺毛霉病的诊治困难;对可疑病例应及时行经皮肺穿刺等组织活检术;可选用伊曲康唑抗毛霉治疗;早期诊断、把握好免疫功能状态是改善预后、减少复发的关键.
목적 탐토신이식후폐모매병적림상특점、영상학표현、진단화치료방법.방법 수집경폐조직활검병리증실적신이식후폐모매병3례적상관자료,기중남성2례,녀성1례,년령위39～54세.균인“뇨독증”접수신이식,1례합병당뇨병,분별우신이식후6개월、2년급6년발병.증상유발열、해수、담중대혈급흉통등.CT영상학표현,2례조기위다발불규칙괴상영,1례조기위쌍폐미만성침윤영;균교쾌진전위다발후벽공동;1례반흉수.3례균경CT인도하경피폐천자병리검사학진.결과 3례중,례1채용이곡강서치료1년,치유,정약8개월후복발;례2이곡강서치료21 d,현효,인이식신발생배척반응,가강면역억제후모매파산,사망;례3경이곡강서치료,현효,잉재수방중.결론 신이식수자병발폐모매병적진치곤난;대가의병례응급시행경피폐천자등조직활검술;가선용이곡강서항모매치료;조기진단、파악호면역공능상태시개선예후、감소복발적관건.
Objective To investigate the clinical features,radiology,diagnosis and treatment of postkidney-transplant pulmonary mucormycosis.Method Three cases of post-kidney-transplant pulmonary mucormycosis were successfully diagnosed by histopathologic examinations.The clinical features of the cases were analyzed.The patients consisted of 2 males and 1 female,aged 39 to 54 yearn All patients were subjected to renal transplantation due to uremia,one was complicated with with diabetes,and pulmonary mucormycosis occurred 6 months,2 years and 6 years after kidney transplant respectively.Fever,cough,bloody sputum and chest pain were the main clinical manifestations.Multiple irregular massive or diffuse infiltrates in the lungs were the early CT findings.In a shoot time,multiple thick-walled cavities occurred in the pulmonary lesions.Pleural effusion was found in one patient.The lung specimens of patients were obtained by CT-guided percutaneous biopsy.Result The first patiem was cured after one year therapy by hraconazole,but recurred after 8 months.The second patient had a marked effect after a 21-day therapy by Itraconazole,but died of disseminated mucor for excessive immunosuppressant against the renal transplantation rejection.The third patient also had a marked effect,and was still in follow up.Condusion The post-kidney-transplant pulmonary mucormycosis is difficult in diagnosis and treatment.CT-guided percutaneous biopsy is one of effective ways for diagnosis.Itraconazole appears to be effective in treatment of pulmonary mucormycosis.Early diagnosis and an appropriate immune ftmction are the keys to improve prognosis and reduce recurrence