【摘要】 目的总结肾移植术后重症肺炎的诊断和治疗体会。方法回顾性分析28例肾移植术后重症肺炎患者的临床资料。结果重症肺炎的发生时间为术后25d至术后10个月,平均3.5个月,其中术后1～6个月发病26例,占总数的93%。临床表现为高热伴进行性呼吸困难。该组经反复检测病原微生物培养、巨细胞病毒(CMV)脱氧核糖核酸(DNA)、CMV免疫球蛋白(Ig)M,24例获得病原学证据(混合性感染20例,单纯细菌感染4例),4例未获得病原学证据。治疗前25例(90%)患者CD4+、CD8+T淋巴细胞计数减少。治疗方案:停用免疫抑制剂,应用免疫增强剂,联合抗细菌、抗病毒、抗真菌,机械通气,营养支持等综合治疗。22例(79%)治愈,其中20例移植肾功能正常,2例血清肌酐轻度升高。6例死于急性呼吸窘迫综合征(ARDS),均为CD4+、CD8+T淋巴细胞计数持续低水平者,其中2例为细菌+真菌+CMV感染者,1例为细菌+CMV感染者,3例为未明确病原菌患者。结论肾移植术后重症肺炎临床表现缺乏特异性,病原学诊断对指导治疗有重要意义,因此需反复进行病原微生物培养、CMVDNA、CMVIgM检测。促进免疫功能恢复、联合应用抗病原微生物药物、对症和支持治疗是成功救治的关键。更多还原

【Abstract】 Objective To evaluate the experiences of diagnosis and treatment of severe pneumonia in renal transplant recipients. Methods Twenty-eight cases of severe pneumonia in renal transplant recipients were retrospectively studied. Results Severe pneumonia occurred from 25 d to 10 months after renal transplantation(mean was 3.5 months). And 26 cases developed severe pneumonia at 1- 6 month after transplantation(93 %). All patients had fever and progressive dyspnea. Microbiology, serum cytomegalovirus(CMV) DNA, CMV IgM, and peripheral blood CD4+, CD8+ T lymphocyte count were examined. Microbiologic examinations showed that 24 cases had microbiology infection(20 cases with mixed infection and 4 cases with bacterial infection), but the other 4 cases had no evidence of microbiologic infection. The CD4+, CD8+ T lymphocytes decreased in 25 cases(90 %)significantly. All patients underwent treatments including immunosuppressants withdraw or reduction, early immunoenhancers application, reasonable administration of antibiotic, antiviral and antifungal regimen, prompt mechanical ventilating assistance as well as sufficient nutrition support. Twenty-two cases recovered(79 %) and 20 of them had normal graft function, in whom 2 cases had a mild increase in serum creatinine(Scr). Six cases died of acute respiratory distress syndrome(ARDS), including 2 patients with CMV, bacteria, fungus infections and 1 patients with CMV, bacteria infections and 3 patients without microbiologic evidence. All the six dead patients showed persistent low level of CD4+, CD8+T cell counts. Conclusions The patients with severe pneumonia post-transplantation usually have non-specific clinical features. Serum CMV DNA, CMV IgM and microbiology examination are valuable for microbiological diagnosis. It is helpful to use the following systemic treatments including enhancing immune function, reasonable administration of antibiotics, symptomatic treatment and adequate nutrition.更多还原