| 摘要: |
| 目的:探讨糖皮质激素联合免疫抑制剂治疗肾脏疾病后并发肺部感染患儿的临床特点。方法:回顾性分析我院收治的100例肾脏疾病患儿应用糖皮质激素联合免疫抑制剂治疗后并发肺部感染的临床资料。结果:所有患儿肺部呼吸系统感染均在联合用药治疗8周后出现,感染出现时间中位数为2.5个月,其中治疗后3个月内发生者71例(71.0%),3~6个月发生者19例(19.0%),>6个月发生者10例(10.0%)。临床症状以进行性呼吸困难为主要表现,其中同时出现发热者81例(81.0%),胸闷气促者38例(38.0%),咳嗽52例(52.0%),病情进展快,43例(43.0%)出现呼吸衰竭。胸部X线片和高分辨CT影像学均显示两肺弥漫性病变。免疫学检查示100例感染患儿免疫功能基本正常,所有患儿病原学检查中HIV抗体阴性,33例患儿(33.0%)检出病原体,共检出65例次,其中23例次(35.4%)为真菌,28例次(43.1%)为细菌,14例次(21.5%)为病毒。患儿明确感染后均停用免疫抑制剂或降低剂量,分别积极给予抗细菌、抗真菌及抗病毒或联合治疗,加强支持治疗,并根据患儿病情予以呼吸机辅助呼吸。14例患儿死亡,病死率为14.0%,其余86例患儿感染得到控制,病情好转出院并门诊随访1个月~1年,患儿肺功能逐渐恢复正常。结论:肾脏疾病患儿应用糖皮质激素联合免疫抑制剂并发肺部感染多发于用药治疗后3个月内,早诊
断、早治疗并及时调整免疫治疗方案有利于改善患儿的预后。 |
| 关键词: 糖皮质激素 免疫抑制剂 肾脏疾病 肺部感染 临床研究 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2018.01.009 |
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| 基金项目: |
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| Clinical Study of Pulmonary Infection Accompanied in Children with Renal Disease on Glucocorticoid and Immunosuppressor Therapy |
| Fan Zhiquan, Yang Weicheng, Fang Hong, Lan Min, Chen Ping |
| (Wuxue First People's Hospital, Hubei Wuxue 435400, China) |
| Abstract: |
| Objective: To observe the clinical characteristics of pulmonary infection during glucocorticoid and immunosuppressor therapy in children with renal disease. Methods: Retrospectively study clinic data of 100 children with renal disease and pulmonary infection after glucocorticoid and immunosuppressor therapy were selected. Results: Pulmonary respiratory infections in all children were found after 8 weeks of combined treatment. The median of the time of infection was 2.5 months, of which 71 cases (71.0%) occurred within 3 months after treatment, 19 cases (19.0%) occurred 3 to 6 months after treatment, 10 cases (10.0%) occurred >6 months after treatment. The clinical symptom of dyspnea was the main performance, 81 cases (81.0%) occurred fever, 38 cases (38.0%) occurred chest tightness shortness of breath, 52 cases (52.0%) occurred coughing, 43 cases (43.0%) occurred respiratory failure. Chest X﹣ray and high resolution CT imaging showed diffuse pulmonary lesions in the whole lung. Immunological examination showed that the immune function of 100 children were basically normal, HIV antibody were negative in the etiological examination of all children. Pathogens were detected in 33 children (33.0%), and 65 cases were found. Among them, 23 cases (35.4%) were fungi, 28 cases (43.1%) were bacteria, 14 cases (21.5%) were virus. All children were blocked up immunosuppressor drugs or reduced the dosage after infection. They were treated with antifungal and antiviral or combined therapy respectively, and supportive treatment was strengthened. Breathing machine assisted respiration was given according to the children's condition. Fourteen children died and the case fatality rate was 14.0%. The other 86 children were controlled by infection and discharged from the hospital, and the children were followed up for 1 month to 1 year. The pulmonary function gradually returned to normal. Conclusion: Renal disease with pulmonary infection treated with glucocorticoid and immunosuppressor therapy mostly occurred in three months. The keys to remedy success are early diagnosis, early treatment and adjustment of immunotherapy in time. |
| Key words: glucocorticoid immunosuppressor renal disease pulmonary infection clinical study |
