1982至2020年中国肾移植受者合并隐球菌病的系统分析

隐球菌病是威胁肾移植患者生命的严重感染性疾病,本文旨在报道我国肾移植患者合并隐球菌病（cryptococcosis in kidney transplant patients,C-KT）的情况。通过对208例患者的资料进行分析,发现隐球菌病平均发病时间为肾移植后(5.48±4.09)年,就诊时间为发病后(27.28±30.69)d,入院后确诊时间为(31.6±44.0)d。本研究中C-KT患者误诊率为23.1%,误诊患者占所有死亡患者的37.5%。此病可侵袭全身各个系统,最常见于中枢神经系统（脑）、呼吸系统（肺）和皮肤等。临床特征除发热、头痛、呕吐外,还常见为恶心、咳嗽、胸闷气短,结节、红斑、脓肿溃疡伴或不伴皮肤疼痛、触痛。诊断方法主要是墨汁染色、乳胶凝集素试验等,检出标本主要为脑脊液,血液,肺泡灌洗液,肺、皮肤病例活检组织等。首选治疗药物为两性霉素B脂质体、氟康唑、5-氟尿嘧啶和伏立康唑等,临床中有氟康唑耐药病例的报道。C-KT患者的总死亡率为15.8%。本文对全面了解肾移植患者合并隐球菌病的特征及对本病的诊断与治疗具有重要的意义。

Systematic analysis of secondary and complicated cryptococcosis in renal transplant recipients in China(1982-2020)

Cryptococcosis is a serious infectious disease that threatens the lives of renal transplant patients. The purpose of this article is to report the situation of cryptococcosis in Chinese renal transplant patients (C-KT). Comprehensive analysis of the collected data of 208 patients indicates that the onset time of cryptococcosis is 5.48±4.09 years after kidney transplantation. There is an interval of 27.28±30.69 days before seeing a doctor after the occurrence of symptoms. The average diagnosis time is 31.6±44.0 days. The misdiagnosis rate of C-KT patients is 23.1%, accounting for 37.5% of all deaths. It can attack all systems of the body, most commonly in the central nervous system (brain), respiratory system (lung), skin, etc. In addition to fever, headache and vomiting, the common clinical features are nausea, cough, chest tightness and shortness of breath, nodular erythema, abscess and ulcer with or without skin pain and tenderness. The main diagnostic methods are Indian ink staining, latex agglutinin test, etc. The detected specimens are mainly cerebrospinal fluid, blood, alveolar lavage fluid, lung and skin case biopsy tissue, etc. The preferred therapeutic agents are amphotericin B liposome, fluconazole, 5-fluorouracil, voriconazole, etc. There are reports of fluconazole-resistant cases in the clinic. The overall mortality rate of C-KT patients is 15.8%. This article provides reference for comprehensive understanding of the characteristics of C-KT and the diagnosis and treatment of this disease.