胸部器官移植中的肺囊炎:当前的观点和最新情况
Seyed M Hosseini-Moghaddam1,2,3, Jay A Fishman4
1Ajmera Transplant Center, Transplant Infectious Diseases Program, University Health Network, University of Toronto, Toronto, ON, Canada.
JHLT open
|September 2, 2025
概括
实体器官移植患者的肺囊炎 (PCP) 难以诊断和治疗. 分子诊断和人工智能的进步提供了更好的检测,同时优化预防和治疗对于更好的结果至关重要.
科学领域:
- 传染性疾病
- 移植医学
- 肺病学
背景情况:
- 肺囊炎肺炎 (PCP) 是胸部固体器官移植 (SOT) 接受者的严重机会性感染,特别是在免疫抑制增加的情况下.
- 由于非特异性症状和难以与其他疾病或殖民区分而导致PCP的延迟诊断是常见的.
- 胸部全移植患者面临PCP严重后果的高风险.
研究的目的:
- 审查目前的胸部SOT接受者的PCP诊断,治疗和预防策略.
- 突出PCP诊断和管理在这个脆弱的人群中的挑战.
- 确定未来研究和基于证据的指导方针的领域.
主要方法:
- 审查最近的诊断技术进步,包括分子方法 (qPCR,ddPCR,LAMP) 和非侵入性方法 (人工智能辅助成像,放射学).
- 讨论当前的第一线治疗 (TMP-SMX) 和替代疗法,以及葡萄皮类药物等辅助治疗的有限证据.
- 免疫抑制管理的分析,预防策略和风险分层工具的需要.
主要成果:
- 分子诊断和基于人工智能的成像显示了更早,更准确的PCP检测的前景.
- 三甲-硫索 (TMP-SMX) 仍然是标准的治疗方法,但最佳的持续时间和剂量需要进一步研究.
- 有效的免疫抑制管理和量身定制的预防是必不可少的,但需要进一步研究以找到最佳策略.
结论:
- 优化诊断工具,完善治疗方案和开发基于证据的预防措施对于降低胸部SOT患者的PCP负担至关重要.
- 需要进一步的研究,包括干预性研究,以制定明确的PCP管理和预防指南.
- 风险分层和量身定制的预防策略对于改善患者的结果至关重要.
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