肺移植后的阿斯伯吉勒斯:预防,危险因素,以及对慢性肺异位移植功能障碍的影响
Johanna P van Gemert1, Ger Jan Fleurke2, Onno W Akkerman1
1Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
概括
在肺移植 (LTx) 后,侵入性肺阿斯伯吉洛症 (IA) 是常见的. 风险因素包括先前的阿斯伯吉勒斯菌,呼吸道问题和某些药物,而他类药物可能会提供一些保护,需要更多的研究.
科学领域:
- 医学研究 医学研究
- 移植免疫学 移植免疫学
- 传染病 传染病 传染病
背景情况:
- 侵入性肺性阿斯伯吉洛症 (IA) 在肺移植 (LTx) 接受者中提出了重大挑战.
- 对于LTx后IA的风险因素和预防策略尚未明确定义.
- 对IA对慢性肺异位移植功能障碍 (CLAD) 和患者死亡率的影响需要进一步调查.
研究的目的:
- 在肺移植接受者中识别与IA相关的风险因素.
- 评估 nebulized amphotericin B (AmB) 和他类药物在预防 IA 的有效性.
- 评估IA对CLAD和死亡率的影响.
主要方法:
- 从2013年12月到2022年1月对LTx患者的回顾性分析.
- 根据既定标准定义的IA;使用后勤回归分析的风险因素.
- 匹配的病例控制研究对他类药物与IA的关联;AMB预防也被评估.
主要成果:
- 在40%的LTx患者中培养了阿斯伯吉路斯菌;81%的人可能有IA.
- 菌酸 (MMF) 的使用,气道狭窄,前LTx Aspergillus,CLAD和急性排斥 (AR) 与IA有关.
- 达丁类药物使用显示出较低IA发病率的趋势,但这在病例对照分析中没有得到证实;AMB预防没有显著的影响. 在全因死亡率上没有显著差异.
结论:
- 在LTx后IA的高发病率凸显了改善预防策略的必要性.
- 干预目标包括先前的Aspergillus培养物,气道狭窄,AR和MMF使用.
- 对于他类药物在IA预防中的作用,需要进一步研究.
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