目的：探讨肾移植术后患者肺部真菌感染的临床特点、治疗措施及其危险因素。方法回顾性分析我院2009年1月~2014年9月我院器官移植科收治的176例肾移植术后并发感染患者的临床资料，其中40例肾移植术后患者诊断为肺部真菌感染，对这40例肾移植术后肺部真菌感染患者的临床症状、体征、影像学表现、病原菌培养或组织病理学检查、治疗以及其他相关病例资料进行总结分析。结果40例肾移植术后肺部真菌感染患者中男性25例，女性15例，平均年龄49岁，28例肺部真菌感染患者发生在肾移植术后6个月内，病原菌培养阳性19例，病原菌中念珠菌属感染17例，其中白色念珠菌11例，克柔氏念珠菌2例，光滑念珠菌3例，热带念珠菌1例，曲霉菌感染1例，假丝酵母菌感染1例，培养阴性21例，合并感染24例。采用抗真菌药物及辅助治疗后38例治愈，死亡2例。结论肾移植术后肺部真菌感染多发生在术后6个月内，病原菌以白色念珠菌最常见，多为混合感染，且病情重、发展快，应尽早明确诊断，及时采用抗真菌药物及综合措施是救治成功的关键。%Objective To explore the clinical characteristics, therapeutic measures and risk factors of pulmonary fungal infection in patients after renal transplantation. Methods The clinical data of 176 patients receiving renal allograft transplantation with postoperative infections were retrospectively analyzed. Among the patients, 40 were diagnosed to have pulmonary fungal infection, and their clinical symptoms, signs, radiographic findings, pathogenic bacterial culture, histopathological examination, and treatments were analyzed. Results The 40 recipients with postoperative pulmonary fungal infection included 25 male and 15 female patients with a mean age of 49 years. Twenty-eight of the patients developed pulmonary fungal infection within 6 months after transplantation. Positive pathogen cultivation was reported in 19 cases, and Candida albicans was detected in 11 cases, Candida krusei in 2 cases, Candida glabrata in 3 cases, Candida tropicalis in 1 case, aspergillosis in 1 case, and Candida mycoderma in 1 case. Twenty-four of out of the 40 cases were found to have co-infection. All the patients received antifungal drugs and adjuvant treatments, and 38 patients were cured and 2 died. Conclusion Pulmonary fungal infection often occurs within 6 months after renal transplantation. The most common fungal pathogen is Candida albicans, and the patients often had coinfections. Early diagnosis and timely intervention with antifungal drugs and comprehensive measures are critical in the management of pulmonary fungal infection following renal transplantation.
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