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目的:讨论肾移植术后并发卡氏肺孢子虫肺炎(PCP)的早期诊断和治疗。方法:对6例肾移植术后并发PCP患者的临床资料进行分析和总结。结果:6例患者经支气管镜肺泡穿刺活检和支气管肺泡灌洗确诊。PCP发病于术后95～172d,一经确诊,根据肾功能及耐受情况予以复方新诺明[SMZco(SMZ50～70mg/(kg.d)TMP10～14mg/(kg.d)治疗3周,同时根据患者外周血CD4+计数及CD4+/CD8+比值调整免疫抑制方案,6例患者均治愈。结论:PCP确诊有赖于肺组织活检或肺泡灌洗找到病原体,必要时诊断性治疗不失为有效方法。治疗首选SMZco,但剂量应结合患者肾功能和耐受情况,并根据患者免疫状态调整免疫抑制方案。
Objective: To discuss the early diagnosis and treatment of pneumocystis carinii pneumonia (PCP) after renal transplantation. Methods: The clinical data of 6 PCP patients after renal transplantation were analyzed and summarized. Results: Six patients were diagnosed by bronchoscopic alveolar biopsy and bronchoalveolar lavage. The incidence of PCP 95 ~ 172d after operation, once diagnosed, according to renal function and tolerance to be given to the new Normin SMZco (SMZ50 ~ 70mg / (kg.d) TMP10 ~ 14mg / (kg.d) treatment for 3 weeks, at the same time The immunosuppressive regimen was adjusted according to the CD4 + count and the ratio of CD4 + / CD8 + in peripheral blood of patients, and 6 patients were cured.Conclusion: PCP diagnosis depends on lung biopsy or alveolar lavage to find the pathogen, and if necessary, diagnostic treatment is an effective method. , But the dose should be combined with the patient’s renal function and tolerance, and adjust the immunosuppressive regimen according to the patient’s immune status.