肝肾移植术后患者隐球菌感染的临床特征分析

发布时间：2018-11-13 18:57

【摘要】：目的:研究肝肾移植术后患者隐球菌感染的临床特征,为肝肾移植术后发生隐球菌感染的危险因素、临床表现、诊断以及治疗和预防等方面提供参考。方法:选取2010年1月到2015年7月在浙江大学医学院附属第一医院就诊的肝、肾移植术后并确诊为隐球菌感染的患者,对其临床特征进行回顾性分析。结果:研究周期内有23例患者符合入组要求,其中肾移植术后21例、肝移植术后2例。对23例患者进行分析,发现单纯隐球菌肺炎6例(占26.0%)、单纯隐球菌性脑膜炎6例(占26.0%)、隐球菌性脑膜炎合并隐球菌肺炎8例(占34.7%)、隐球菌败血症2例(占8.6%)、皮肤隐球菌感染1例(占4.3%)。所有隐球菌肺炎均经肺穿刺病理确诊,临床表现以发热,咳嗽咳痰,气急症状居多。胸部CT表现为结节、空洞、肿块、渗出等。所有隐球菌脑膜炎患者中9例经脑脊液培养出新生隐球菌、7例脑脊液墨汁染色见隐球菌,其中3例培养及涂片均为阳性。临床表现以头痛、发热、呕吐症状居多,1例并发癫痫,1例并发意识障碍。所有患者分别给予氟康唑、两性霉素B、氟胞嘧啶针、伏立康唑等抗真菌治疗,其中3例隐球菌脑膜炎患者予两性霉素B鞘内注射;经1～6个月治疗后,总体预后情况良好(好转22例,死亡1例)。结论:肝、肾移植术后患者因免疫抑制剂的长期使用,隐球菌感染值得重视,其临床症状不典型,易误诊及漏诊,通过对其主要症状及影像学特点判断,结合肺穿刺活检、脑脊液检查、血培养等检查手段,可明显提高隐球菌感染的检出率,从而做到早诊断,早治疗,降低病死率。
[Abstract]:Objective: to study the clinical features of Cryptococcus infection in patients after liver and kidney transplantation, and to provide reference for the risk factors, clinical manifestations, diagnosis, treatment and prevention of Cryptococcus infection after liver and kidney transplantation. Methods: from January 2010 to July 2015, the patients with Cryptococcus infection were selected from the first affiliated Hospital of Zhejiang University Medical College, and their clinical characteristics were analyzed retrospectively. Results: during the study period, 23 patients met the requirement of admission, including 21 cases after renal transplantation and 2 cases after liver transplantation. Among the 23 patients, 6 cases (26.0%) were Cryptococcus simplex pneumonia, 6 cases (26.0%) were Cryptococcal meningitis, 8 cases (34.7%) were Cryptococcal Meningitis combined with Cryptococcal pneumonia. Cryptococcus septicemia 2 cases (8.6%), skin Cryptococcus infection 1 case (4.3%). All cases of Cryptococcus pneumoniae were confirmed by lung puncture pathology, the clinical manifestations were fever, cough and expectoration, and acute symptoms of qi. Chest CT features nodule, cavity, mass, exudation, etc. Cryptococcus neoformans were cultured in cerebrospinal fluid in 9 of all patients with Cryptococcus meningitis, Cryptococcus was found in 7 cases in ink stain of cerebrospinal fluid, among which 3 cases were positive in culture and smear. The clinical manifestations were headache, fever and vomiting, 1 case complicated with epilepsy and 1 case complicated with disturbance of consciousness. All patients were treated with fluconazole, amphotericin B, fluorocytosine needle, and voleconazole respectively. Among them, 3 patients with cryptococcal meningitis were given amphotericin B intrathecal injection. After 1 ~ 6 months treatment, the overall prognosis was good (22 cases improved, 1 case died). Conclusion: Cryptococcus infection is worthy of attention due to the long-term use of immunosuppressive agents in patients after liver and kidney transplantation, and its clinical symptoms are atypical, misdiagnosed and missed. The detection rate of Cryptococcus infection can be improved by cerebrospinal fluid examination and blood culture, so as to make early diagnosis, early treatment and reduce mortality.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R617;R519
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本文编号：2330141