肾移植受者侵袭性肺曲霉菌病的临床特征和预后:单中心经验

IF 1.6 4区 医学 Q4 IMMUNOLOGY
Jilin Zou, Zeya Jin
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引用次数: 0

摘要

目的本研究旨在探讨肾移植(RT)后患者侵袭性肺曲霉菌病(IPA)的临床特征、早期诊断方法和治疗方法:我们回顾性研究了 2005 年至 2024 年期间在我院接受治疗的 22 例肾移植术后确诊为 IPA 的患者:患者平均年龄为(46.4±9.4)岁,男性占多数(72.7%)。RT后IPA的发生率为1.29%。移植后出现IPA的中位时间为12个月。发热是主要症状(72.7%),其次是咳嗽和痰多(31.8%)和咯血(13.6%)。常见的计算机断层扫描结果包括合并症(68.2%)和空洞(45.5%),并伴有光晕征、多发结节和气新月征。五名患者出现中性粒细胞减少,其中一例出现粒细胞减少。59.1%的患者肾功能受损。45.5%的患者血清1,3-β-D-葡聚糖和半乳甘露聚糖(GM)检测呈阳性,83.3%的患者支气管肺泡灌洗液GM检测证实为IPA。下一代测序证实 11 名患者感染了曲霉菌。最终,68.2%的患者痊愈,31.8%的患者因感染而死亡,死亡患者的并发症发生率明显较高:结论:IPA患者的死亡率很高。结论:IPA 患者的死亡率很高。RT 后的 IPA 症状通常没有特异性,因此诊断非常困难。事实证明,支气管肺泡灌洗液 GM 检测和下一代测序作为 IPA 的检测方法相对有用。应尽快开始抗真菌治疗,以避免并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical characteristics and outcomes of invasive pulmonary aspergillosis in renal transplant recipients: A single-center experience

Objective

This study aimed to explore the clinical features, early diagnostic methods, and therapeutic approaches for invasive pulmonary aspergillosis (IPA) in patients after renal transplantation (RT).

Methods

We retrospectively examined 22 patients who were diagnosed with IPA post-RT and treated at our institution between 2005 and 2024.

Results

Patients had an average age of 46.4 ± 9.4 years, with a predominance of men (72.7 %). The incidence of IPA after RT was 1.29 %. The median time of IPA onset after transplantation was 12 months. Fever was the predominant symptom (72.7 %), followed by cough and expectoration (31.8 %) and hemoptysis (13.6 %). Frequent computed tomography findings included consolidations (68.2 %) and cavities (45.5 %) with halo signs, multiple nodules, and air crescent signs. Neutropenia was noted in five patients, including one case of agranulocytosis. Impaired renal function was observed in 59.1 % of the cases. Serum 1,3-β-D-glucan and galactomannan (GM) assays were positive in 45.5 % of patients, with bronchoalveolar lavage fluid GM tests confirming IPA in 83.3 % of those tested. Next-generation sequencing confirmed Aspergillus infection in 11 patients. Ultimately, 68.2 % of the patients recovered, whereas 31.8 % succumbed to the infection, with the deceased demonstrating a significantly high rate of complications.

Conclusions

Patients with IPA had high mortality rates. The symptoms of IPA after RT are usually nonspecific, making diagnosis very difficult. Bronchoalveolar lavage fluid GM testing and next-generation sequencing proved relatively helpful as detection methods for IPA. Antifungal treatments should be initiated as soon as possible to avoid complications.
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来源期刊
Transplant immunology
Transplant immunology 医学-免疫学
CiteScore
2.10
自引率
13.30%
发文量
198
审稿时长
48 days
期刊介绍: Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.
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