肾移植术后肺部感染患者病原体及危险因素分析

doi:10.3969/j.issn.1006-6233.2021.02.022

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摘要 目的: 了解肾移植术后肺部感染的发生情况、病原体分布以及相关危险因素。方法: 对2017年4月至2019年4月在广州医科大学附属第二医院器官移植科接受肾移植手术共627例患者的临床资料进行回顾性分析。结果: 随访期内,627例患者中有105例(16.75%)发生肺部感染,其中5例(4.76%)发生在移植后1个月内,61例(58.10%)发生在2~6个月内,39例(37.14%)发生在6个月以后。105例肺部感染患者病原体检测阳性者70例,样本类型以痰液和血液为主,占89.33%,咽拭子及胸水占10.67%。其中细菌感染54例次(55.10%)、真菌感染16例次(16.33%)、CMV病毒感染12例次(12.24%)、卡氏肺孢子菌感染1例次(1.02%)以及混合感染15例次(15.31%)。铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、嗜麦芽窄食单胞菌和金黄色葡萄球菌是位于前五位的病原体。单因素分析显示,患者有糖尿病史(P=0.044)、白细胞计数<4×10⁹L^-1(P=0.015)、出现肾功能延迟恢复(P=0.008)和发生急性排斥反应(P=0.037)是肾移植术后发生肺部感染的危险因素。经多因素分析发现,白细胞计数<4×10⁹L^-1(OR=2.499,95%CI1.321~4.726,P=0.005)、出现肾功能延迟恢复(OR=2.894,95%CI 1.128~7.429,P=0.027)和发生急性排斥反应(OR=2.233,95%CI 1.121~4.446,P=0.022)是肺部感染发生的独立危险因素。结论: 术后2~6个月是肾移植术后肺部感染的高发时期。收集不同来源的样本和联合多种检测方法可以提高病原体的检出率。术后白细胞计数<4×10⁹L^-1、出现肾功能延迟恢复和急性排斥反应的患者是肾移植术后肺部感染的高危人群。

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	邓聪
	孙卫民
	林梅双
	林艳芬

关键词 ：肾移植术, 肺部感染, 病原体, 危险因素

Abstract：Objective: To investigate the characteristics, pathogen spectrum and risk factors for pulmonary infection in kidney transplant recipients. Methods: We performed a retrospective cohort study reviewing the medical records of 627 patients who had undergone kidney transplantation at The Second Affiliated Hospital Of Guangzhou Medical University from April 2017 to April 2019. Results: One hundred and five(16.75%)patients developed pulmonary infection during the follow-up period. Five cases(4.76%)of pulmonary infection occurred within 1month after surgery, sixty-one cases(58.10%)occurred within 2～6 months and 39 cases(37.14%)occurred more than 6 months after surgery, respectively. Among 105 patients, 70 patients had been detected positively with pathogens. The pathogens isolated from sputum and blood sampls accounted for 89.33%, isolated from throat swab and pleural effusion sampls accounted for 10.67%, respectively. The pathogens identified in 70 patients indicated that 54 (55.10%) cases were bacteria, 16 (16.33%) were fungus, 12 (12.24%) were cytomegalovirus, 1(1.02%)was pneumocystis carinii and 15 (15.31%) were complicated infection. The most common organisms were Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Stenococcus maltophilia and Staphylococcus aureus. Univariate analysis demonstrated that diabetes history(P=0.044), WBC＜4×10⁹L^-1(P=0.015), delayed graft function (P=0.008)and acute rejection(P=0.037)were risk factors of pulmonary infection in kidney transplant recipients. Multivariate logistic regression analysis showed that WBC＜4×10⁹L^-1(OR=2.499,95%CI 1.321～4.726, P=0.005), delayed graft function(OR=2.894,95%CI 1.128～7.429, P=0.027) and acute rejection(OR=2.233,95%CI 1.121～4.446, P=0.022)were independent risk factors associated with the development of pulmonary infection in kidney transplant recipients. Conclusion: Pulmonary infection most commonly occurs within 2～6 months after kidney transplantation. Collecting various samples from different sites and combination of different detection methods can increase the detection rate of pathogens. The patients who have WBC＜4×10⁹L^-1, delayed graft function or acute rejection after kidney transplantation are at increased risk of developing pulmonary infection.

Key words： Kidney transplantation Pulmonary infection Pathogen Risk factor

基金资助:广东省医学科学技术研究基金项目,(编号:A2019472);广东省医学科学技术研究基金项目,(编号:A2017050)

通讯作者: 林艳芬

引用本文:

邓聪, 孙卫民, 林梅双, 林艳芬. 肾移植术后肺部感染患者病原体及危险因素分析[J]. 河北医学, 2021, 27(2): 279-283.
DENG Cong, SUN Weimin, LIN Meishuang, et al. An Analysis of Pathogen Spectrum and Risk Factors for Pulmonary Infection in Kidney Transplant Recipients. HeBei Med, 2021, 27(2): 279-283.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.02.022 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I2/279

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