• 四川大學(xué)華西醫(yī)院腎臟內(nèi)科（成都，610041）;

目的 　總結(jié)腎移植術(shù)后肺部感染的臨床表現(xiàn)、病原學(xué)及救治措施，以提高其治愈率。 方法　 對(duì)四川大學(xué)華西醫(yī)院50例次腎移植術(shù)后肺部感染住院患者的病歷資料進(jìn)行回顧性分析。 結(jié)果 　共收集42例（50例）次腎移植肺部感染患者，痰培養(yǎng)檢出病原體38例次（76%），未檢出12例次，其中細(xì)菌感染17例次（44.7%），真菌感染7例次（18.4%），巨細(xì)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(fā)生在腎移植術(shù)后1個(gè)月以內(nèi)者3例（7%），1～6個(gè)月者16例（38%），6個(gè)月以后者23例（55%）。50例次感染患者中48例次經(jīng)積極治療搶救后好轉(zhuǎn)出院，有2例患者死亡。 結(jié)論 　腎移植術(shù)后肺部感染患者的病原體與腎移植術(shù)后時(shí)間有一定的規(guī)律性。對(duì)于腎移植術(shù)后肺部感染，救治成功的關(guān)鍵是早期病原體及CT檢查，及時(shí)給予綜合治療措施，包括經(jīng)驗(yàn)性抗生素治療措施，及時(shí)調(diào)整免疫抑制劑方案，加強(qiáng)全身支持。

引用本文： 王瑩瑩,張艷玲,劉亞,唐曉紅,陶冶. 腎移植術(shù)后肺部感染的臨床表現(xiàn)及病原學(xué)分析. 華西醫(yī)學(xué), 2012, 27(6): 837-840. doi: 復(fù)制

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(yī)學(xué)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(bào)告[J]. 第二軍醫(yī)大學(xué)學(xué)報(bào), 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(shí)用內(nèi)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(shù)后肺部感染臨床分析[J]. 四川醫(yī)學(xué), 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(shù)后并發(fā)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(shù)后肺部感染的CT診斷[J]. 實(shí)用臨床醫(yī)學(xué), 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(shù)后應(yīng)用新型免疫抑制劑受者肺部感染的臨床研究[J]. 南方醫(yī)科大學(xué)學(xué)報(bào), 2008, 28(6): 1037-1040.
22. 　趙杰, 明英姿, 牛英, 等. 腎移植術(shù)后28例臨床分析[J]. 現(xiàn)代醫(yī)藥衛(wèi)生, 2010, 26(20): 3078-3079.
  1. 1. 　Sia IG, Paya CV. Infectious complications following renal transplantation[J]. Surg Clin North Am, 1998, 78(1): 95-112.
  2. 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(yī)學(xué)雜志, 2001, 18(2): 20-23.
  3. 3. 　閔志廉, 朱有華, 何長民, 等. 尸體腎移植1011例次的臨床報(bào)告[J]. 第二軍醫(yī)大學(xué)學(xué)報(bào), 1994, 15(5): 401-406.
  4. 4. 　Briggs JD. Cause of death after renal transplantion[J]. Nephrol Dial Transplant, 2001, 16(11): 1545-1549.
  5. 5. 　陳萍, 兀威. 糖尿病合并肺部感染的診治[J]. 中國實(shí)用內(nèi)科雜志, 2004, 24(6): 324-325.
  6. 6. 　Rubin RH. The impact of mtectuous on the outcome of transplantation[J]. Transplant Proc, 1991, 23(4): 2068-2074.
  7. 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. 8. 　John GT, Shankar V, Abraham AM. Risk factors for post transplant tuberculosis[J]. Kidney Int, 2001, 60(3): 1148-1153.
  9. 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. 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. 11. 　Hoyo I, Linares L, Cervera C. Epidemiology of pneumonia in kidney transplantation[J]. Transplant Proc, 2010, 42(8): 2938-2940.
  12. 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. 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. 14. 　錢翠, 梁宗安. 腎移植術(shù)后肺部感染臨床分析[J]. 四川醫(yī)學(xué), 2009, 30(2): 167-169.
  15. 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. 16. 　滕琳, 劉婷, 李香美, 等. 腎移植術(shù)后并發(fā)肺部感染10例分析[J]. 中國感染與化療雜志, 2010, 10(4): 270-272.
  17. 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. 18. 　廖鳳翔, 魏江平, 劉大仁. 腎移植術(shù)后肺部感染的CT診斷[J]. 實(shí)用臨床醫(yī)學(xué), 2007, 8(8): 103-105.
  19. 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. 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. 21. 　張彥選，于立新，付紹杰, 等. 腎移植術(shù)后應(yīng)用新型免疫抑制劑受者肺部感染的臨床研究[J]. 南方醫(yī)科大學(xué)學(xué)報(bào), 2008, 28(6): 1037-1040.
  22. 22. 　趙杰, 明英姿, 牛英, 等. 腎移植術(shù)后28例臨床分析[J]. 現(xiàn)代醫(yī)藥衛(wèi)生, 2010, 26(20): 3078-3079.