Retrospective Analysis on Clinical Features and Pathogen Kinds of Pulmonary Infection after Kidney Transplantation_West China Medical Journal

Authors：

WANG Yingying , ZHANG Yanling , LIU Ya ,  TANG Xiaohong , TAO Ye

Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

TANG Xiaohong, Email: wangyingying2009hx@126.com

Keywords：

腎移植術后; 肺部感染; 病原菌; 診斷; 治療

Video：

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目的　總結腎移植術后肺部感染的臨床表現、病原學及救治措施，以提高其治愈率。方法　對四川大學華西醫院50例次腎移植術后肺部感染住院患者的病歷資料進行回顧性分析。結果　共收集42例（50例）次腎移植肺部感染患者，痰培養檢出病原體38例次（76%），未檢出12例次，其中細菌感染17例次（44.7%），真菌感染7例次（18.4%），巨細胞病毒感染19例次（38%），支原體感染6例次（12%），混合感染10例次（20%）。肺部感染發生在腎移植術后1個月以內者3例（7%），1～6個月者16例（38%），6個月以后者23例（55%）。50例次感染患者中48例次經積極治療搶救后好轉出院，有2例患者死亡。結論　腎移植術后肺部感染患者的病原體與腎移植術后時間有一定的規律性。對于腎移植術后肺部感染，救治成功的關鍵是早期病原體及CT檢查，及時給予綜合治療措施，包括經驗性抗生素治療措施，及時調整免疫抑制劑方案，加強全身支持。

Citation： WANG Yingying,ZHANG Yanling,LIU Ya,TANG Xiaohong,TAO Ye. Retrospective Analysis on Clinical Features and Pathogen Kinds of Pulmonary Infection after Kidney Transplantation. West China Medical Journal, 2012, 27(6): 837-840. doi: Copy

1.	Sia IG, Paya CV. Infectious complications following renal transplantation[J]. Surg Clin North Am, 1998, 78(1): 95-112.
2.	唐雅望, 張玉海, 賈寶祥, 等. 腎移植2200例次臨床分析[J]. 中華醫學雜志, 2001, 18(2): 20-23.
3.	閔志廉, 朱有華, 何長民, 等. 尸體腎移植1011例次的臨床報告[J]. 第二軍醫大學學報, 1994, 15(5): 401-406.
4.	Briggs JD. Cause of death after renal transplantion[J]. Nephrol Dial Transplant, 2001, 16(11): 1545-1549.
5.	陳萍, 兀威. 糖尿病合并肺部感染的診治[J]. 中國實用內科雜志, 2004, 24(6): 324-325.
6.	Rubin RH. The impact of mtectuous on the outcome of transplantation[J]. Transplant Proc, 1991, 23(4): 2068-2074.
7.	Santos CAQ, Brennan DC. Infections in kidney transplant recipien[M]//McKay DB, Steinberg SM. Kidney transplantation: a guide to the care of kidney transplant recipients. New York: Springer, 2010: 277-309.
8.	John GT, Shankar V, Abraham AM. Risk factors for post transplant tuberculosis[J]. Kidney Int, 2001, 60(3): 1148-1153.
9.	Kalra V, Agarwal SK, Khilnani GC, et al. Spectrum of pulmonary infections in renal transplant recipients in the tropics: a single center study[J]. Int Urol Nephrol, 2005, 37(3): 551-559.
10.	Chen G, Zhang Z, Gu J, et al. Incidence and risk factors for pulmonary mycosis in kidney transplantation[J]. Transplant pro, 2010, 42(10): 4094-4098.
11.	Hoyo I, Linares L, Cervera C. Epidemiology of pneumonia in kidney transplantation[J]. Transplant Proc, 2010, 42(8): 2938-2940.
12.	Kalra V, Agarwal SK, Khilnani GC, et al. Spectrum of pulmonary infections in renal transplant recipients in the tropics: a single center study[J]. Int Urol Nephrol, 2005, 37(3): 551-559.
13.	Menon LR, Divate S, Acharya VN, et al. Utility of bronchoalveolar lavage in the diagnosis of pulmonary infections in immunosuppressed patients[J]. J Assoc Physicians India, 2002, 50: 1110-1114.
14.	錢翠, 梁宗安. 腎移植術后肺部感染臨床分析[J]. 四川醫學, 2009, 30(2): 167-169.
15.	Jung M, Krech U, Price PC, et al. Evidence of chronic persistent infections with polyomaviruses (BK type) in renal transplant recipients[J]. Arch Virol, 1975, 47(1): 39-46.
16.	滕琳, 劉婷, 李香美, 等. 腎移植術后并發肺部感染10例分析[J]. 中國感染與化療雜志, 2010, 10(4): 270-272.
17.	Jiang T, Xue F, Zheng X, et al. Clinical data and CT findings of pulmonary infection caused by different pathogens after kidney transplantation[J]. Eur J Radiol, http://dx.doi.org/10.1016/j.ejrad.2011.03.070.
18.	廖鳳翔, 魏江平, 劉大仁. 腎移植術后肺部感染的CT診斷[J]. 實用臨床醫學, 2007, 8(8): 103-105.
19.	Yin S, Powell EC, Trainor JL. Serious bacterial infections in febirle outpatient pediatric kidney transplant recipients[J]. Pediatr Infect Dis J, 2011, 30(2): 136-140.
20.	Eid AJ, Arthurs SK, Deziel PJ, et al. Emergence of drug-resistant cytomegalovirus in the era of valganciclovir prophylaxis: therapeutic implications and outcomes[J]. Clin Transplant, 22(2): 162-170.
21.	張彥選，于立新，付紹杰, 等. 腎移植術后應用新型免疫抑制劑受者肺部感染的臨床研究[J]. 南方醫科大學學報, 2008, 28(6): 1037-1040.
22.	趙杰, 明英姿, 牛英, 等. 腎移植術后28例臨床分析[J]. 現代醫藥衛生, 2010, 26(20): 3078-3079.

1. 　Sia IG, Paya CV. Infectious complications following renal transplantation[J]. Surg Clin North Am, 1998, 78(1): 95-112.
2. 　唐雅望, 張玉海, 賈寶祥, 等. 腎移植2200例次臨床分析[J]. 中華醫學雜志, 2001, 18(2): 20-23.
3. 　閔志廉, 朱有華, 何長民, 等. 尸體腎移植1011例次的臨床報告[J]. 第二軍醫大學學報, 1994, 15(5): 401-406.
4. 　Briggs JD. Cause of death after renal transplantion[J]. Nephrol Dial Transplant, 2001, 16(11): 1545-1549.
5. 　陳萍, 兀威. 糖尿病合并肺部感染的診治[J]. 中國實用內科雜志, 2004, 24(6): 324-325.
6. 　Rubin RH. The impact of mtectuous on the outcome of transplantation[J]. Transplant Proc, 1991, 23(4): 2068-2074.
7. 　Santos CAQ, Brennan DC. Infections in kidney transplant recipien[M]//McKay DB, Steinberg SM. Kidney transplantation: a guide to the care of kidney transplant recipients. New York: Springer, 2010: 277-309.
8. 　John GT, Shankar V, Abraham AM. Risk factors for post transplant tuberculosis[J]. Kidney Int, 2001, 60(3): 1148-1153.
9. 　Kalra V, Agarwal SK, Khilnani GC, et al. Spectrum of pulmonary infections in renal transplant recipients in the tropics: a single center study[J]. Int Urol Nephrol, 2005, 37(3): 551-559.
10. 　Chen G, Zhang Z, Gu J, et al. Incidence and risk factors for pulmonary mycosis in kidney transplantation[J]. Transplant pro, 2010, 42(10): 4094-4098.
11. 　Hoyo I, Linares L, Cervera C. Epidemiology of pneumonia in kidney transplantation[J]. Transplant Proc, 2010, 42(8): 2938-2940.
12. 　Kalra V, Agarwal SK, Khilnani GC, et al. Spectrum of pulmonary infections in renal transplant recipients in the tropics: a single center study[J]. Int Urol Nephrol, 2005, 37(3): 551-559.
13. 　Menon LR, Divate S, Acharya VN, et al. Utility of bronchoalveolar lavage in the diagnosis of pulmonary infections in immunosuppressed patients[J]. J Assoc Physicians India, 2002, 50: 1110-1114.
14. 　錢翠, 梁宗安. 腎移植術后肺部感染臨床分析[J]. 四川醫學, 2009, 30(2): 167-169.
15. 　Jung M, Krech U, Price PC, et al. Evidence of chronic persistent infections with polyomaviruses (BK type) in renal transplant recipients[J]. Arch Virol, 1975, 47(1): 39-46.
16. 　滕琳, 劉婷, 李香美, 等. 腎移植術后并發肺部感染10例分析[J]. 中國感染與化療雜志, 2010, 10(4): 270-272.
17. 　Jiang T, Xue F, Zheng X, et al. Clinical data and CT findings of pulmonary infection caused by different pathogens after kidney transplantation[J]. Eur J Radiol, http://dx.doi.org/10.1016/j.ejrad.2011.03.070.
18. 　廖鳳翔, 魏江平, 劉大仁. 腎移植術后肺部感染的CT診斷[J]. 實用臨床醫學, 2007, 8(8): 103-105.
19. 　Yin S, Powell EC, Trainor JL. Serious bacterial infections in febirle outpatient pediatric kidney transplant recipients[J]. Pediatr Infect Dis J, 2011, 30(2): 136-140.
20. 　Eid AJ, Arthurs SK, Deziel PJ, et al. Emergence of drug-resistant cytomegalovirus in the era of valganciclovir prophylaxis: therapeutic implications and outcomes[J]. Clin Transplant, 22(2): 162-170.
21. 　張彥選，于立新，付紹杰, 等. 腎移植術后應用新型免疫抑制劑受者肺部感染的臨床研究[J]. 南方醫科大學學報, 2008, 28(6): 1037-1040.
22. 　趙杰, 明英姿, 牛英, 等. 腎移植術后28例臨床分析[J]. 現代醫藥衛生, 2010, 26(20): 3078-3079.

West China Medical Journal

Retrospective Analysis on Clinical Features and Pathogen Kinds of Pulmonary Infection after Kidney Transplantation

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