摘要
目的探讨肝移植术后中远期肺部真菌感染的临床表现、诊断方法、治疗措施及转归。方法对医院12例肝移植术后中远期肺部真菌感染患者的临床资料进行回顾性分析。结果12例患者,确诊3例,临床诊断4例,高危疑似5例,其中,肺穿刺活检发现新型隐球酵母菌包囊1株,胸水培养发现白色假丝酵母菌1株,支气管镜灌洗液培养发现光滑假丝酵母菌1株;乳胶凝集试验阳性2例,G试验及GM试验均阳性2例,9例CT检查表现为局限性高密度团块影,3例为多发片状及絮状影;10例治疗患者,治愈8例,好转1例,死亡1例;有效率90.0%,治愈率80.0%,死亡率8.3%,2例未治患者病情稳定。结论肝移植术后中远期肺部真菌感染以曲霉菌属和隐球酵母菌属为主,在临床表现、病程转归及药物耐受性方面有别于肝移植术后早期肺部真菌感染。
OBJECTIVE To investigate the clinical feature, diagnosis, treatment and outcome in mid-later stage after liver transplantation. METHODS The clinical data of 12 patients with pulmonary fungal infection in the mid-later stage after liver transplantation were analyzed retrospectively. RESULTS The three cases were definite, four cases were with clinical diagnosis, five cases were with high-risk suspected infection, in which 1 strain of Cryptococcous neoformans was found by biopsy of pulmonary tissue, 1 strain of Candida albicans was diagnosed by hydrothorax incubation, 1 strain of C. glabrata was diagnosed by bronchoalveolar lavage incubation. The two cases were positive in latex agglutination test, and other two cases were positive in both of galactomannan and 1→ 3〉-β-D-glucan test. CT finding indicated the pulmonary nodules or masses in 9 cases. Plaque and floceulation lesion found in 3 cases. Ten cases were treated, in which 8 cases were cured, 1 case was improved, 1 case was dead. The effective rate was 90%, the curative rate was 80%, and the mortality rate was 8.3%. The two cases without treatment were stable. CONCLUSIONS The leading etiologic species of pulmonary fungal infections in the mid-later stage after liver transplantation are Aspergillus and Cryptococcous. It is different between early stage and mid-later stage after liver transplantation on clinical feature, outcome and anti-fungal medicine tolerability.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2009年第16期2096-2098,共3页
Chinese Journal of Nosocomiology
关键词
肝移植
肺脏
真菌感染
转归
Liver transplantation
Lung
Fungal infection
Outcome
