肾移植术后并发肺孢子菌病的诊断与治疗
[Diagnosis and therapy of pneumocystosis complicated after renal transplantation].
作者信息
Sun Ming, Yang Yu-ru, Lu Yi-ping, Wang Li, Tang Ke-shi, Wei Qiang, Li Hong
机构信息
Department of Urology, Westchina Hospital, Sichuan University, Chengdu 610041, China.
出版信息
Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 2004 Aug;22(4):245-7.
OBJECTIVE
To investigate the early diagnosis, treatment and prevention of pneumocystosis complicated after renal transplantation.
METHODS
Data from 12 cases of kidney transplant recipients who developed pneumocystosis were analyzed by clinical symptoms and signs, results of laboratory examination, imaging, bronchoscopy and biopsy. Combined TMP/SMZ was used for the prevention and treatment.
RESULTS
Pneumocystis carinii (Pc) detection rate was 16.7% from alveolar douche, 66.7% with bronchoscopy and biopsy. Two cases was diagnosed by PCR method with sputum. Plain chest film showed 58.3% of lung cirrhosis. CT showed 50% frosted glass-like change in lungs and 25% with lung consolidation. Eleven cases were cured but one died.
CONCLUSION
Pc detection by bronchoscopy and biopsy, and PCR are most helpful in the diagnosis of pneumocystosis complicated with renal transplantation, in addition to plain chest film and CT scaning. Combined TMP/SMZ is effective in the prevention and treatment of pneumocystosis.
目的
探讨肾移植术后并发肺孢子菌病的早期诊断、治疗及预防方法。
方法
对12例肾移植受者发生肺孢子菌病的资料进行临床症状体征、实验室检查结果、影像学、支气管镜及活检分析。采用复方磺胺甲恶唑进行防治。
结果
肺泡灌洗肺孢子菌（Pc）检出率为16.7%，支气管镜及活检检出率为66.7%。2例痰标本采用PCR方法确诊。胸部平片显示58.3%有肺纹理增粗。CT显示50%肺部有磨砂玻璃样改变，25%有肺实变。11例治愈，1例死亡。
结论
除胸部平片及CT扫描外，支气管镜及活检、PCR检测Pc对肾移植并发肺孢子菌病的诊断最有帮助。复方磺胺甲恶唑对肺孢子菌病防治有效。
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