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目的探讨肾移植术后肺部曲霉菌属感染的早期诊断和治疗。方法回顾性分析肾移植术后9例符合临床诊断和临床拟诊肺部曲霉菌属感染患者的临床资料。结果9例临床诊断和拟诊侵袭性肺曲霉菌病(IPA)的患者中,血培养确诊黑曲霉菌性肺炎1例次,痰培养诊断肺曲霉菌属感染3例次,半乳甘露聚糖试验(GM试验)阳性5例次,CT扫描典型表现诊断2例次;合并巨细胞病毒(CMV)或细菌感染6例,合并假丝酵母菌属感染1例,单纯IPA 2例;7例临床拟诊后立即给与伏立康唑静脉注射,其中有2例合并或序贯给予米卡芬净治疗,1例给予伊曲康唑注射液,1例给予卡泊芬净注射液治疗;合并CMV感染者给予更昔洛韦,合并细菌感染者给予敏感抗菌药物;治愈8例,1例放弃治疗后死亡。结论对肾移植术后拟诊曲霉菌属感染者应结合GM试验、CT扫描和临床表现,尽早进行经验性治疗以减少死亡率。
Objective To investigate the early diagnosis and treatment of pulmonary aspergillosis after renal transplantation. Methods Retrospective analysis of 9 cases of renal transplant patients with clinical diagnosis and clinical diagnosis of pulmonary aspergillosis in patients with clinical data. Results Among the 9 clinically diagnosed and diagnosed patients with invasive pulmonary aspergillosis (IPA), 1 case of Aspergillus oryzae pneumonia was confirmed in blood culture, 3 cases of pulmonary aspergillosis infection in sputum and 3 cases of galactomannan (GM test) was positive in 5 cases, typical CT scan was diagnosed in 2 cases; with cytomegalovirus (CMV) or bacterial infection in 6 cases, with Candida infection in 1 case, simple IPA in 2 cases; 7 cases of clinical Immediately after the diagnosis, intravenous voriconazole was given, of which 2 were treated with micafungin in combination or sequentially, 1 case with itraconazole injection and 1 case with caspofungin injection. Patients with CMV infection Give ganciclovir, combined with bacterial infections were given sensitive antibacterial drugs; cured in 8 cases, 1 patient gave up treatment after death. Conclusion Aspergillosis should be combined with GM test, CT scan and clinical manifestation after renal transplantation, so as to reduce the mortality as soon as possible.