实体器官移植术后隐球菌病研究进展

doi:10.3877/cma.j.issn.1674-3903.2020.04.016

隐球菌病是实体器官移植受者术后第三常见的侵袭性真菌病，以中枢神经系统及肺部感染为主。由于临床表现缺乏特异性，其早期诊断及预防性抗真菌治疗对于器官移植受者预后具有重要意义。本文综述了隐球菌病的流行病学、发病机制、临床表现、防治策略及疾病转归。

关键词: 隐球菌病, 隐球菌肉芽肿, 新型隐球菌, 格特隐球菌, 实体器官移植

Cryptococcosis is the third most common invasive fungal disease in solid organ transplant recipients, primarily involves brain and lungs. Since the lack of specific symptoms, early diagnosis and optimal antifungal prophylaxis are of great significance to the solid organ transplant recipients. This article reviews the research progress in the epidemiological features, pathogenesis, clinical manifestation, treatment and prognosis of cryptococcosis.

Key words: Cryptococcosis, Cryptococcoma, Cryptococcus neoformans, Cryptococcus gattii, Solid organ transplantation

表1 中枢神经系统隐球菌病、播散性感染及中、重度肺隐球菌病推荐治疗方案

治疗方案	药物和剂量	治疗时间
首选治疗	两性霉素B脂质体(3～4 mg·kg^-1·d^-1)，两性霉素B脂质复合体(5 mg·kg^-1·d^-1)＋5-氟胞嘧啶(100 mg·kg^-1·d^-1)	≥2周
替代治疗	两性霉素B脂质体(3～4 mg·kg^-1·d^-1)，两性霉素B脂质复合体(5 mg·kg^-1·d^-1)	≥4～6周
巩固	氟康唑(400～800 mg/d)	8周
维持	氟康唑(200～400 mg/d)	≥6～12个月

表1 中枢神经系统隐球菌病、播散性感染及中、重度肺隐球菌病推荐治疗方案

治疗方案	药物和剂量	治疗时间
首选治疗	两性霉素B脂质体(3～4 mg·kg^-1·d^-1)，两性霉素B脂质复合体(5 mg·kg^-1·d^-1)＋5-氟胞嘧啶(100 mg·kg^-1·d^-1)	≥2周
替代治疗	两性霉素B脂质体(3～4 mg·kg^-1·d^-1)，两性霉素B脂质复合体(5 mg·kg^-1·d^-1)	≥4～6周
巩固	氟康唑(400～800 mg/d)	8周
维持	氟康唑(200～400 mg/d)	≥6～12个月

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Research progress on cryptococcosis after solid organ transplantation

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Research progress on cryptococcosis after solid organ transplantation