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：

肾移植术后; 肺部感染; 病原菌; 诊断; 治疗

Video：

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目的　总结肾移植术后肺部感染的临床表现、病原学及救治措施，以提高其治愈率。方法　对四川大学华西医院50例次肾移植术后肺部感染住院患者的病历资料进行回顾性分析。结果　共收集42例（50例）次肾移植肺部感染患者，痰培养检出病原体38例次（76%），未检出12例次，其中细菌感染17例次（44.7%），真菌感染7例次（18.4%），巨细胞病毒感染19例次（38%），支原体感染6例次（12%），混合感染10例次（20%）。肺部感染发生在肾移植术后1个月以内者3例（7%），1～6个月者16例（38%），6个月以后者23例（55%）。50例次感染患者中48例次经积极治疗抢救后好转出院，有2例患者死亡。结论　肾移植术后肺部感染患者的病原体与肾移植术后时间有一定的规律性。对于肾移植术后肺部感染，救治成功的关键是早期病原体及CT检查，及时给予综合治疗措施，包括经验性抗生素治疗措施，及时调整免疫抑制剂方案，加强全身支持。

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, 张玉海, 贾宝祥, 等. 肾移植2200例次临床分析[J]. 中华医学杂志, 2001, 18(2): 20-23.
3.	闵志廉, 朱有华, 何长民, 等. 尸体肾移植1011例次的临床报告[J]. 第二军医大学学报, 1994, 15(5): 401-406.
4.	Briggs JD. Cause of death after renal transplantion[J]. Nephrol Dial Transplant, 2001, 16(11): 1545-1549.
5.	陈萍, 兀威. 糖尿病合并肺部感染的诊治[J]. 中国实用内科杂志, 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.	钱翠, 梁宗安. 肾移植术后肺部感染临床分析[J]. 四川医学, 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, 刘婷, 李香美, 等. 肾移植术后并发肺部感染10例分析[J]. 中国感染与化疗杂志, 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.	廖凤翔, 魏江平, 刘大仁. 肾移植术后肺部感染的CT诊断[J]. 实用临床医学, 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.	张彦选，于立新，付绍杰, 等. 肾移植术后应用新型免疫抑制剂受者肺部感染的临床研究[J]. 南方医科大学学报, 2008, 28(6): 1037-1040.
22.	赵杰, 明英姿, 牛英, 等. 肾移植术后28例临床分析[J]. 现代医药卫生, 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, 张玉海, 贾宝祥, 等. 肾移植2200例次临床分析[J]. 中华医学杂志, 2001, 18(2): 20-23.
3. 　闵志廉, 朱有华, 何长民, 等. 尸体肾移植1011例次的临床报告[J]. 第二军医大学学报, 1994, 15(5): 401-406.
4. 　Briggs JD. Cause of death after renal transplantion[J]. Nephrol Dial Transplant, 2001, 16(11): 1545-1549.
5. 　陈萍, 兀威. 糖尿病合并肺部感染的诊治[J]. 中国实用内科杂志, 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. 　钱翠, 梁宗安. 肾移植术后肺部感染临床分析[J]. 四川医学, 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, 刘婷, 李香美, 等. 肾移植术后并发肺部感染10例分析[J]. 中国感染与化疗杂志, 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. 　廖凤翔, 魏江平, 刘大仁. 肾移植术后肺部感染的CT诊断[J]. 实用临床医学, 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. 　张彦选，于立新，付绍杰, 等. 肾移植术后应用新型免疫抑制剂受者肺部感染的临床研究[J]. 南方医科大学学报, 2008, 28(6): 1037-1040.
22. 　赵杰, 明英姿, 牛英, 等. 肾移植术后28例临床分析[J]. 现代医药卫生, 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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