背景:高氨血症综合征(HS)是一种罕见的移植后并发症,与高发病率和死亡率相关。在肺移植受者中,其发病率似乎更高,其病理生理学尚不清楚。除了潜在的代谢异常,推测HS可能与脲原体或支原体有关。肺部感染。这种情况的管理没有标准化,可能包括先发制人的抗菌药物,肾脏替代,氮气清除,和肠道净化疗法,以及饮食调整。
方法:在本例系列中,我们描述了七个HS病例,其中5人排除了代谢缺陷。此外,按照PRISMA-P指南检索PubMed进行文献综述.从1997年1月1日至2021年10月31日,对含有术语“高氨血症”和“肺”的文章进行了审查。
结果:我们中心描述的所有HS病例的支原体科气道样本均呈阳性,神经系统异常和高氨水平移植后。我们组的死亡率(57%)与先前病例中公布的死亡率相似。文献综述支持HS是移植后的早期并发症,与脲原体有关。出现脑水肿和癫痫发作的患者的人支原体感染和预后较差。
结论:这篇综述强调了快速检测脲原体的必要性。肺移植后的人马,以及未来研究探索可能改善这些患者预后的潜在治疗方法的必要性。
BACKGROUND: Hyperammonemia syndrome (HS) is a rare post-transplant complication associated with high morbidity and mortality. Its incidence appears to be higher in lung transplant recipients and its pathophysiology is not well understood. In addition to underlying metabolic abnormalities, it is postulated that HS may be associated with Ureaplasma or Mycoplasma spp. lung infections. Management of this condition is not standardized and may include preemptive antimicrobials, renal replacement, nitrogen scavenging, and bowel decontamination therapies, as well as dietary modifications.
METHODS: In this case series, we describe seven HS cases, five of whom had metabolic deficiencies ruled out. In addition, a literature review was performed by searching PubMed following PRISMA-P guidelines. Articles containing the terms \"hyperammonemia\" and \"lung\" were reviewed from 1 January 1997 to 31 October 2021.
RESULTS: All HS cases described in our center had positive airway samples for Mycoplasmataceae, neurologic abnormalities and high ammonia levels post-transplant. Mortality in our group (57%) was similar to that published in previous cases. The literature review supported that HS is an early complication post-transplant, associated with Ureaplasma spp. and Mycoplasma hominis infections and of worse prognosis in patients presenting cerebral edema and seizures.
CONCLUSIONS: This review highlights the need for rapid testing for Ureaplasma spp. and M. hominis after lung transplant, as well as the necessity for future studies to explore potential therapies that may improve outcomes in these patients.