Abstract:

Objective To investigate the pathogenic microbiological characteristics， clinical characteristics，diagnosis and treatment experience of interstitial pneumonia after renal transplantation. Methods The 109 patientswith interstitial pneumonia after renal transplantation diagnosed in the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to June 2022 were selected. The clinical characteristics，results of pathogenic microbiology， antiinfection strategies and clinical outcomes were analyzed retrospectively. ResultsPathogenic diagnosis of interstitialpneumonia after renal transplantation was difficult， and mixed infection was the main pathogenesis. The main pathogenswere pneumocystis jirovecii in 26 cases （23.9%）， cytomegalovirus in 22 cases （20.2%）， mycoplasma in 15 cases （13.8%），and klebsiella pneumoniaein 13cases （11.9%）. After comprehensive treatment，97 patients（89.0%） were cured and 12（11.0%） died. ConclusionThe diagnosis of interstitial pneumonia after renal transplantation is based on clinical symptoms and imaging manifestations. Pneumocystis jirovecii and cytomegalovirus are the main pathogens. Dynamicmonitoring， early diagnosis and early preventive full course treatment should be carried out for high-risk patients. In the clinic， the key to the treatment of interstitial pneumonia is to provide oxygen support in time， adjust the immunosuppression scheme， reduce inflammatory factors， timely check the next generation sequencing （NGS），and transform from empirical totargeted effective anti-infection therapy. At the same time， immune function of the body and effective nutritional support are necessary. 

Key words:

Renal transplantation； , Interstitial pneumonia； , Immunity

摘要：

目的 探讨肾移植术后间质性肺炎的病原微生物学特点、临床特征和诊疗经验。方法 选择2018 年 1 月至 2022 年 6 月在西安交通大学第一附属医院确诊的肾移植术后间质性肺炎患者 109 例，回顾性分析临床特点、病原微生物学检查结果、抗感染策略及临床转归。结果 肾移植术后间质性肺炎病原学诊断较为困难，常以混合感染为主，主要病原体为耶氏肺孢子菌 26 例（23.9%）、巨细胞病毒 22 例（20.2%）、支原体 15 例（13.8%）、肺炎克雷伯菌 13 例（11.9%）。经综合治疗 97 例（89.0%）患者痊愈出院，12 例（11.0%）死亡。结论 肾移植术后间质性肺炎目前诊断基于临床表现与影像学表现，病原体以耶氏肺孢子菌与巨细胞病毒为主，对高危患者应动态监测，早期诊断、早期预防性足疗程治疗。临床上间质性肺炎治疗的关键在于及时吸氧、调整免疫抑制方案、减轻炎症因子，并及时完善病原学二代测序（next generation sequencing，NGS）等检查、由经验性转为针对性有效抗感染，同时提高机体免疫功能和有效营养支持。

关键词:

肾移植 , 间质性肺炎 , 免疫功能