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肾脏病与透析肾移植杂志 ›› 2012, Vol. 21 ›› Issue (5): 408-412.

• 论文 • 上一篇    下一篇

重症肾脏疾病患者并发肺部真菌感染的临床特征

  

  • 出版日期:2012-10-24 发布日期:2012-10-24

Analysis of pulmonary fungus infection in patients with chronic kidney diseases.

  • Online:2012-10-24 Published:2012-10-24

摘要:

摘要 目的:分析和探讨肾脏疾病合并肺部真菌感染的临床特征及其易感因素。 方法:采用回顾性方法对2009年11月至2011年11月我院肾脏ICU收治的合并肺部真菌感染的肾脏病患者共25例的基本临床资料进行分析,所有患者均有病原学及影像学依据明确为肺部真菌感染,根据病原学及药敏结果给予抗真菌治疗。 结果:在我院肾脏ICU收治的肾脏病患者中,肺部真菌感染占2.9%(25/874)。其中男13例,女12例;年龄21-76岁,平均52.1岁;其中狼疮性肾炎6例,ANCA相关性系统性血管炎5例,肾移植术后患者3例,原发性肾病综合征 5例,慢性肾功能不全3例,糖尿病肾病、多发性骨髓瘤和流行性出血热各1例。感染病原最常见的是白色假丝酵母菌(13例,52%),其次是曲霉菌(8例,32%),另有热带假丝酵母菌2例,光滑假丝酵母菌和新型隐球菌各1例。19例患者(76%)在感染前使用免疫抑制治疗。易感因素有高龄,免疫抑制剂应用,贫血,低蛋白血症,免疫功能异常,合并糖尿病,呼吸机应用等。 结论:肾脏疾病行免疫抑制治疗患者易并发肺部真菌感染,最常见病原菌是白色假丝酵母菌,控制易感因素、早期诊断、及时治疗是控制真菌感染的有效途径。

关键词: 慢性肾脏病, 肺部真菌感染, 危险因素

Abstract:

ABSTRACT Objective: To investigate the incidence, clinical manifestation and risk factors of pulmonary fungus infection in hospitalized patients with chronic kidney disease (CKD). Methodology: Twenty five patients, who acquired pulmonary fungus infection with CKD in our centre during from Nov 2009 to Nov 2011, were enrolled this study. Their clinical manifestation and risk factors of pulmonary fungus infection were retrospectively investigated. All patients had pathogen and image examination, and accepted antifungal drugs. Results: 25 cases (2.9%) of pulmonary fungus infection were found among 874 in renal ICU。 They were 13 males and 12 females with the age ranged from 21 to 76 years old. The patients with lupus nephritis and systemic vasculitis were easy to get infection. Among them, 13 cases were infected with Candida albicans, 8 with Aspergillus, 2 with Candida tropicalis, one with Candida glabirate and one with Crypococcus. 19 cases of them (76%) were taken immunosuppressant before infection. The predisposing factors included advanced age, immunosuppressant, anemia, hypoproteinemia, immune deficiency, diabetes and use respirator. Conclusion: The patients who received immunosuppressive drugs may predispose to pulmonary fungus infection, and the most common fungus was Candida albicans. The prognosis will be better if the predisposing factors be controlled and the diagnosis and treatment is in time.

Key words: kidney disease, pulmonary fungus infection, risk factors