Abstract:

Objective To study and analyze the clinical features and risk factors of lung infection afterkidney transplantation. Methods A retrospective analysis of 162 patients undergoing kidney transplantation inour hospital from January 2015 to December 2019 was performed. Patients were divided into three groups based on whether they had pulmonary fungal infection within 6 months after operation，the patients with pulmonary fungal infection after operation were included in the fungal infection group，those with pulmonary bacterial infection were included in the bacterial infection group，and those without pulmonary infection were included in the non-infected group. The clinical data of the three groups of patients were analyzed and the risk factors affecting lung infection after kidney transplantation were investigated. Results Of the 162 kidney transplant patients，46（28.39%）had lung infections. Bacterial infection patients accounted for 52.17%（24/46），fungal infection patients accounted for 41.30%（19/46），and no pathogen was detected in 1 patient. Fungal infections were mainly Candida albicans，Aspergillus，Candida，and Pneumocystis. Its clinical symptoms were mainlyfever，cough，sputum expectoration，dyspnea，and blood in sputum. CT manifestations were complex andchangeable，showing a variety of properties and morphological changes. The results of multivariate analysis showed that age ≥ 60 years，delayed postoperative renal function recovery，acute rejection，white blood cell（WBC）＜ 3.5×109/L，and albumin（ALB）＜ 40 g/L were risk factors for lung infection after kidney transplantation（P＜0.05）. Conclusion The proportion of fungal infections in the lungs after kidney transplantation is similar as that of bacterial infections. The clinical manifestations and CT manifestations of patients with fungal infection are non-specific. Therefore，the diagnosis of fungal infection after kidney transplantation relies on thecombination of clinical manifestations of the patient，microbiology，CT imaging and pathology.Patients withadvanced age，delayed postoperative renal function recovery，acute rejection，WBC ＜ 3.5×109/L，and ALB ＜40 g/L are high-risk groups of lung infection after kidney transplantation. These people should be closely monitored after surgery to reduce the chance of infection. 

Key words:

Kidney transplant, Lung fungal infection, Clinical features, Risk factors

摘要：

目的 分析肾移植术后肺部真菌感染的临床特征及其危险因素。方法 采用回顾性研究，选取 2015 年 1 月— 2019 年 12 月在解放军联勤保障部队第九二三医院进行肾移植手术的 162 例患者作为研究对象。分析患者肺部感染的临床特征，并依据患者术后 6 个月内发生肺部感染情况，将术后发生肺部真菌感染的患者纳入真菌感染组，发生肺部细菌感染的患者纳入细菌感染组，未发生肺部感染的患者纳入非感染组。对 3 组患者的临床资料进行分析并找出影响肾移植术后肺部真菌感染的危险因素。结果 162 例肾移植患者中，46 例（28.39%）发生肺部感染。其中细菌感染患者占 52.17%（24/46），真菌感染患者占 41.30%（19/46），1 例患者未检出任何病原体。真菌感染主要以白色念珠菌、曲霉菌、假丝酵母菌、肺孢子菌为主 ；其临床症状主要表现为发热、咳嗽、咳痰、呼吸困难、痰中带血等 ；CT 表现复杂多变，呈多种性质和形态改变。多因素分析结果显示，年龄≥ 60 岁、术后肾功能延迟恢复、急性排斥反应、白细胞（white blood cell，WBC）＜ 3.5×109/L、白蛋白（albumin，ALB）＜ 40 g/L 是肾移植术后肺部感染的危险因素（P ＜ 0.05）。 结论 肾移植术后肺部真菌感染的占比与细菌感染的占比基本一致。真菌感染患者的临床表现及 CT 表现缺乏特异性，因此肾移植术后真菌感染的诊断需根据患者临床表现，结合微生物学、CT 影像学以及病理学结果综合考量。高龄、术后肾功能延迟恢复、急性排斥反应、WBC ＜ 3.5×109/L、ALB ＜ 40 g/L 的患者是肾移植术后肺部感染的高危人群，术后应密切关注此类人群以减少感染发生率。

关键词:

肾移植 , 肺部真菌感染 , 临床特征 , 危险因素