亲属活体肾移植受者卡氏肺孢子菌肺炎相关危险因素分析
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摘要
目的探讨亲属活体肾移植受者卡氏肺孢子菌肺炎(PCP)的相关危险因素,以期早期预防及识别PCP。方法采用回顾性研究,在安徽省立医院病案室收集从2010年8月—2018年8月36例亲属活体肾移植受者发生PCP的患者,将其纳入PCP组,其中病原学确诊为11例,临床诊断有25例。同时收集同期住院的亲属活体肾移植受者未发生PCP的患者共49例,纳为非PCP组。收集PCP组与非PCP组的供者年龄、受体性别及年龄、肾移植前透析时间、有无巨细胞病毒感染、从移植到发生PCP或者肺部其他感染时间、中性粒细胞、淋巴细胞、发生PCP或肺部其他感染时钙离子(Ca)浓度、肌酐、有无糖尿病、多囊肾、有无肾性高血压及有无排斥反应等指标。结果单因素分析发现淋巴细胞、血清Ca均是影响亲属活体肾移植受者术后发生PCP的危险因素(P<0.05),且多因素分析发现淋巴细胞和Ca是影响PCP发生的独立因素(P<0.05)。结论在亲属活体肾移植受者中,淋巴细胞≤0.97×109/L,Ca>2.305 mmol/L是预测其发生PCP的有效指标。
Objective To study the risk factors associated with pneumocystis pneumonia(PCP) in living kidney transplant recipients so as to prevent and identify PCP early. Methods A retrospective study was conducted to collect 36 cases of PCP infection in living related kidney recipients who were treated in Anhui Provincial Hospital from August 2010 to August 2018. Among them, 11 cases were confirmed by etiology, and 25 cases were clinically diagnosed. A total of 49 cases not infected PCP were collected as non-PCP group. Donor age and recipient gender and age, dialysis time before kidney transplantation, cytomegalovirus(CMV) infection, time from transplantation to PCP infection, neutrophils and lymphocytes, serum calcium concentration during PCP infection, creatinine, diabetes, hypertensive nephropathy, combined rejection reaction between the two groups were compared. Results The result of univariate analysis showed that there were significant differences in lymphocyte and Ca level between PCP group and non-PCP group(P<0.05). The result of multifactors analysis showed that lymphocyte and Ca level were the independent factors of PCP(P<0.05). Conclusion In the related living renal transplant recipients, lymphocyte≤0.97×109/L and Ca>2.305 mmol/L are the effective indicators for the prediction of PCP.
Objective To study the risk factors associated with pneumocystis pneumonia(PCP) in living kidney transplant recipients so as to prevent and identify PCP early. Methods A retrospective study was conducted to collect 36 cases of PCP infection in living related kidney recipients who were treated in Anhui Provincial Hospital from August 2010 to August 2018. Among them, 11 cases were confirmed by etiology, and 25 cases were clinically diagnosed. A total of 49 cases not infected PCP were collected as non-PCP group. Donor age and recipient gender and age, dialysis time before kidney transplantation, cytomegalovirus(CMV) infection, time from transplantation to PCP infection, neutrophils and lymphocytes, serum calcium concentration during PCP infection, creatinine, diabetes, hypertensive nephropathy, combined rejection reaction between the two groups were compared. Results The result of univariate analysis showed that there were significant differences in lymphocyte and Ca level between PCP group and non-PCP group(P<0.05). The result of multifactors analysis showed that lymphocyte and Ca level were the independent factors of PCP(P<0.05). Conclusion In the related living renal transplant recipients, lymphocyte≤0.97×109/L and Ca>2.305 mmol/L are the effective indicators for the prediction of PCP.
引文
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[11]Chen WC,Chang SC,Wu TH,et al.Hypercalcemia in a renal transplant recipient suffering with Pneumocystis carinii pneumonia[J].Am J Kidney Dis,2002,39(2):E8.
[12]Chatzikyrkou C,Clajus C,Haubitz M,et al.Hypercalcemia and pneumocystis Pneumonia after kidney transplantation:report of an exceptional case and literature review[J].Transpl Infect Dis,2011,13(5):496-500.
[13]Hung YM.Pneumocystis carinii pneumonia with hypercalcemia and suppressed parathyroid hormone levels in a renal transplant patient[J].Transplantation,2006,81(4):639.
[14]Aguirre AR,Balbo BE,Ianhez LE,et al.Hypercalcemia and suppressed PTH levels in a renal transplant patient infected with Pneumocystis carinii[J].Ren Fail,2007,29(4):513-516.
[15]Hajji K,Dalle F,Harzallah A,et al.Vitamin D metabolite-mediated hypercalcemia with suppressed parathormone concentration in Pneumocystis jiroveci pneumonia after kidney transplantation[J].Transpl Proc,2009,41(8):3320-3322.
[2]赵铁梅,佘丹阳,解立新,等.非艾滋病免疫功能抑制患者肺孢子菌肺炎的临床特点及诊治探讨[J].中华医院感染学杂志,2014,24(6):1384-1386.
[3]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):253-279.
[4]Borstnar S,Lindic J,Tomazic J,et al.Pneumocystis Jirovecii Pneumonia in Renal Transplant Recipients:A National Center Experience[J].Transpl Proc,2013,45(4):1614-1617.
[5]李珺,徐道亮,刘昌华.非AIDS患者与肺孢子菌肺炎[J].中华临床医师杂志(电子版),2014,8(22):161-166.
[6]Struijk GH,Gijsen AF,Yong SL,et al.Risk of Pneumocystis jiroveci pneumonia in patients long after renal transplantation[J].Nephrol Dial Transpl,2011,26(10):3391-3398.
[7]Arichi N,Kishikawa H,Mitsui Y,et al.Cluster outbreak of Pneumocystis pneumonia among kidney transplant patients within a single center[J].Transpl Proc,2009,41(1):170-172.
[8]Muhammad Iqbal AH,Lim SK,Ng KP,et al.Pneumocystis jirovecii pneumonia 13 years post renal transplant following a recurrent cytomegalovirus infection[J].Transpl Infect Dis,2012,14(4):E23-E26.
[9]Borstnar S,Lindic J,Tomazic J,et al.Pneumocystis jirovecii pneumonia in renal transplant recipients:a national center experience[J].Transpl Proc,2013,45(4):1614-1617.
[10]De Boer MGJ,Kroon FP,Le Cessie S,et al.Risk factors for Pneumocystis jirovecii pneumonia in kidney transplant recipients and appraisal of strategies for selective use of chemoprophylaxis[J].Transpl Infect Dis,2015,13(6):559-569.
[11]Chen WC,Chang SC,Wu TH,et al.Hypercalcemia in a renal transplant recipient suffering with Pneumocystis carinii pneumonia[J].Am J Kidney Dis,2002,39(2):E8.
[12]Chatzikyrkou C,Clajus C,Haubitz M,et al.Hypercalcemia and pneumocystis Pneumonia after kidney transplantation:report of an exceptional case and literature review[J].Transpl Infect Dis,2011,13(5):496-500.
[13]Hung YM.Pneumocystis carinii pneumonia with hypercalcemia and suppressed parathyroid hormone levels in a renal transplant patient[J].Transplantation,2006,81(4):639.
[14]Aguirre AR,Balbo BE,Ianhez LE,et al.Hypercalcemia and suppressed PTH levels in a renal transplant patient infected with Pneumocystis carinii[J].Ren Fail,2007,29(4):513-516.
[15]Hajji K,Dalle F,Harzallah A,et al.Vitamin D metabolite-mediated hypercalcemia with suppressed parathormone concentration in Pneumocystis jiroveci pneumonia after kidney transplantation[J].Transpl Proc,2009,41(8):3320-3322.