【摘要】：目的:研究肝腎移植術(shù)后患者隱球菌感染的臨床特征,為肝腎移植術(shù)后發(fā)生隱球菌感染的危險(xiǎn)因素、臨床表現(xiàn)、診斷以及治療和預(yù)防等方面提供參考。方法:選取2010年1月到2015年7月在浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院就診的肝、腎移植術(shù)后并確診為隱球菌感染的患者,對(duì)其臨床特征進(jìn)行回顧性分析。結(jié)果:研究周期內(nèi)有23例患者符合入組要求,其中腎移植術(shù)后21例、肝移植術(shù)后2例。對(duì)23例患者進(jìn)行分析,發(fā)現(xiàn)單純隱球菌肺炎6例(占26.0%)、單純隱球菌性腦膜炎6例(占26.0%)、隱球菌性腦膜炎合并隱球菌肺炎8例(占34.7%)、隱球菌敗血癥2例(占8.6%)、皮膚隱球菌感染1例(占4.3%)。所有隱球菌肺炎均經(jīng)肺穿刺病理確診,臨床表現(xiàn)以發(fā)熱,咳嗽咳痰,氣急癥狀居多。胸部CT表現(xiàn)為結(jié)節(jié)、空洞、腫塊、滲出等。所有隱球菌腦膜炎患者中9例經(jīng)腦脊液培養(yǎng)出新生隱球菌、7例腦脊液墨汁染色見(jiàn)隱球菌,其中3例培養(yǎng)及涂片均為陽(yáng)性。臨床表現(xiàn)以頭痛、發(fā)熱、嘔吐癥狀居多,1例并發(fā)癲癇,1例并發(fā)意識(shí)障礙。所有患者分別給予氟康唑、兩性霉素B、氟胞嘧啶針、伏立康唑等抗真菌治療,其中3例隱球菌腦膜炎患者予兩性霉素B鞘內(nèi)注射;經(jīng)1～6個(gè)月治療后,總體預(yù)后情況良好(好轉(zhuǎn)22例,死亡1例)。結(jié)論:肝、腎移植術(shù)后患者因免疫抑制劑的長(zhǎng)期使用,隱球菌感染值得重視,其臨床癥狀不典型,易誤診及漏診,通過(guò)對(duì)其主要癥狀及影像學(xué)特點(diǎn)判斷,結(jié)合肺穿刺活檢、腦脊液檢查、血培養(yǎng)等檢查手段,可明顯提高隱球菌感染的檢出率,從而做到早診斷,早治療,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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R617;R519
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本文編號(hào)：2330141