肺移植术后侵袭性真菌感染的危险因素及对术后早期死亡风险的影响分析-东南大学学报医学版

肺移植术后侵袭性真菌感染的危险因素及对术后早期死亡风险的影响分析

单位：南京医科大学附属无锡人民医院, 江苏无锡 214023

分类号：R655.3

出版年·卷·期（页码）：2023·42·第一期（132-139）

摘要：

目的：探讨肺移植术后侵袭性真菌感染的危险因素及对术后早期死亡风险的影响，以期为降低真菌感染的发生率及预防术后早期死亡提供依据。方法：回顾性纳入南京医科大学附属无锡人民医院肺移植中心2019年1月至2020年12月行肺移植手术的291例患者为研究对象，收集术后30 d内真菌感染发生情况，及供-受体、随访资料，采用单因素及多因素二分类非条件Logistic回归探索真菌感染发生的影响因素，通过Kaplan-Meier法和多因素Cox回归分析真菌感染对其术后死亡风险的影响。结果：肺移植受者术后30 d内真菌感染率为13.4%（39/291）。肺部原发病是影响术后早期真菌感染的因素，与尘肺相比，继发性肺间质纤维化（OR=9.957，95%CI：1.244~79.685，P=0.030）、特发性肺间质纤维化（OR=7.548，95%CI：0.948~60.119， P=0.056）发生感染的风险更高。生存分析显示，术后早期真菌感染对30 d （HR=2.86，95%CI：0.868~9.419）、90 d （HR=1.272，95%CI：0.618~2.619）、180 d （HR=1.198，95%CI：0.681~0.626）及1年（HR=1.206，95%CI：0.680~2.139）的死亡风险影响均无统计学意义。结论：肺间质纤维化患者移植术后易发生早期真菌感染，但尚未观察到肺移植受者术后早期真菌感染会造成术后早期死亡风险的增加。

Objective: To investigate the risk factors of invasive fungal infections and impact of early death after lung transplantation, so as to provide evidence for reducing the incidence of fungal infections and early death. Methods: A total of 291 patients who underwent lung transplantation in the Lung Transplant Center of Wuxi Peoples Hospital Affiliated to Nanjing Medical University from January 2019 to December 2020 were retrospectively included in the study. The occurrence of fungal infection within 30 days after surgery, donor-recipient and follow-up data were collected. Univariate and multivariate binary unconditional logistic regression were used to explore the influencing factors of fungal infection. Kaplan-Meier method and multivariate Cox regression were used to analyze the influence of fungal infection on the risk of postoperative death. Results: The rate of fungal infection within 30 days after lung transplantation was 13.4%(39/291). Primary pulmonary disease was an important factor affecting early postoperative fungal infection. Compared with pneumoconiosis, secondary pulmonary interstitial fibrosis(OR=9.957, 95%CI: 1.244-79.685, P=0.030) and idiopathic pulmonary interstitial fibrosis(OR=7.548, 95%CI: 0.948-60.119, P=0.056) had a higher risk of infection. Survival analysis showed that early postoperative fungal infection was more effective in 30 days(HR=2.86, 95%CI: 0.868-9.419), 90 days(HR=1.272, 95%CI: 0.618-2.619) and 180 days(HR=1.198, 95%CI: 0.681-0.626) and 1-year(HR=1.206, 95%CI: 0.680-2.139) mortality risk were not statistically significant. Conclusion: Patients with pulmonary interstitial fibrosis are prone to early fungal infections after transplantation, but an increase in early death has not been found in lung transplant recipients with early fungal infections.

参考文献：

[1] MATTNER F, FISCHER S, WEISSBRODT H, et al.Postoperative nosocomial infections after lung and heart transplantation[J].J Heart Lung Transplant, 2007, 26(3):241-249.
[2] 张坚磊.实体器官移植受者侵袭性真菌感染的实验室诊断[J/CD].实用器官移植电子杂志, 2018, 6(3):234-239.
[3] NEOFYTOS D, GARCIA-VIDAL C, LAMOTH F, et al.Invasive aspergillosis in solid organ transplant patients:diagnosis, prophylaxis, treatment, and assessment of response[J].BMC Infect Dis, 2021, 21(1):296.
[4] 谷兴丽, 徐思成, 刘光明, 等.侵袭性肺真菌感染的危险因素、临床表现与预后[J].临床肺科杂志, 2015, 20(11):2090-2093.
[5] ARTHURS S K, EID A J, DEZIEL P J, et al.The impact of invasive fungal diseases on survival after lung transplantation[J].Clin Transplant, 2010, 24(3):341-348.
[6] HUSAIN S, CAMARGO J F.Invasive aspergillosis in solid-organ transplant recipients:guidelines from the American Society of Transplantation Infectious Diseases Community of Practice[J].Clin Transplant, 2019, 33(9):e13544.
[7] JU C, LIAN Q, XU X, et al.Epidemiology and prognosis of invasive fungal disease in Chinese lung transplant recipients[J].Front Med(Lausanne), 2021, 8:718-747.
[8] 中华医学会器官移植学分会.器官移植受者侵袭性真菌病临床诊疗技术规范(2019版)[J].器官移植, 2019, 10(3):227-236.
[9] AGUILAR C A, HAMANDI B, FEGBEUTEL C, et al.Clinical risk factors for invasive aspergillosis in lung transplant recipients:results of an international cohort study[J].J Heart Lung Transplant, 2018, 37(10):1226-1234.
[10] CAMARGO J F, HUSAIN S.Immune correlates of protection in human invasive aspergillosis[J].Clin Infect Dis, 2014, 59(4):569-577.
[11] KOTLOFF R M, AHYA V N, CRAWFORD S W.Pulmonary complications of solid organ and hematopoietic stem cell transplantation[J].Am J Respir Crit Care Med, 2004, 170(1):22-48.
[12] SEGAL B H, WALSH T J.Current approaches to diagnosis and treatment of invasive aspergillosis[J].Am J Respir Crit Care Med, 2006, 173(7):707-717.
[13] SOLÉ A, MORANT P, SALAVERT M, et al.Aspergillus infections in lung transplant recipients:risk factors and outcome[J].Clin Microbiol Infect, 2005, 11(5):359-365.
[14] MARIK P E.Fungal infections in solid organ transplantation[J].Expert Opin Pharmacother, 2006, 7(3):297-305.
[15] SINGH N, HUSAIN S.Aspergillus infections after lung transplantation:clinical differences in type of transplant and implications for management[J].J Heart Lung Transplant, 2003, 22(3):258-266.
[16] ALEXANDER B D, TAPSON V F.Infectious complications of lung transplantation[J].Transpl Infect Dis, 2001, 3(3):128-137.
[17] DOLIGALSKI C T, BENEDICT K, CLEVELAND A A, et al.Epidemiology of invasive mold infections in lung transplant recipients[J].Am J Transplant, 2014, 14(6):1328-1333.
[18] VAZQUEZ R, VAZQUEZ-GUILLAMET M C, SUAREZ J, et al.Invasive mold infections in lung and heart-lung transplant recipients:Stanford University experience[J].Transpl Infect Dis, 2015, 17(2):259-266.
[19] PAPPAS P G, ALEXANDER B D, ANDES D R, et al.Invasive fungal infections among organ transplant recipients:results of the transplant-associated infection surveillance network(TRANSNET)[J].Clin Infect Dis, 2010, 50(8):1101-1111.
[20] CHONG P P, KENNEDY C C, HATHCOCK M A, et al.Epidemiology of invasive fungal infections in lung transplant recipients on long-term azole antifungal prophylaxis[J].Clin Transplant, 2015, 29(4):311-318.
[21] HUSAIN S, SILVEIRA F P, AZIE N, et al.Epidemiological features of invasive mold infections among solid organ transplant recipients:PATH Alliance Rregistry analysis[J].Med Mycol, 2017, 55(3):269-277.
[22] STEINBACH W J, MARR K A, ANAISSIE E J, et al.Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry[J].J Infect, 2012, 65(5):453-464.
[23] NEOH C F, SNELL G I, KOTSIMBOS T, et al.Antifungal prophylaxis in lung transplantation:a world-wide survey[J].Am J Transplan, 2011, 11(2):361-366.
[24] HUSAIN S, SOLE A, ALEXANFER B D, et al.The 2015 International Society for Heart and Lung Transplantation Guidelines for the management of fungal infections in mechanical circulatory support and cardiothoracic organ transplant recipients:executive summary[J].J Heart Lung Transplant, 2016, 35(3):261-282.
[25] PERLIN D S, RAUTEMAA-RICHARDSON R, ALASTRUEY-IZQUIERDO A.The global problem of antifungal resistance:prevalence, mechanisms, and management[J].Lancet Infect Dis, 2017, 17(12):e383-e392.

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