目的:肾病综合征(NS)患者长期服激素、免疫抑制剂可出现免疫功能缺陷,易继发少见病原菌感染,分析并总结NS合并播散性奴卡菌病患者的临床表现、诊断、治疗及预后。方法:回顾性分析南京军区南京总医院肾脏科近年来收治的9例出现奴卡菌感染的NS患者,对其临床特征进行分析。结果:男性3例,女性6例,平均年龄33.6±9.8岁。9例患者均曾使用激素及免疫抑制剂,出现感染时服泼尼松剂量为34.4±12.6 mg/d。激素治疗至出现感染的中位时间为6月(2~51月),其中6例感染发生在6个月内。8例患者出现发热,平均38.8℃±1.0℃。白细胞升高8例(8/9),C反应蛋白升高8例(8/8),降钙素原轻度升高1例(1/5)。4例(4/7)患者CD4+T淋巴细胞减低,其中3例<200个/μl。9例患者均有肺部感染,其中5例表现为孤立或散在的结节状或团块状密度增高影,病灶多贴近胸膜,部分形成空洞。其他部位受累包括皮肤7例、胸腔3例、肝周脓肿2例,颅脑、眼、肾上腺各1例。皮肤脓液及胸水培养阳性率均达到100%。星形、豚鼠、巴西奴卡菌各1例,余6例未能分型。7例患者在诱导治疗时使用复方新诺明(TMP-SMX),其中2例联合、另有2例单用碳青霉烯类药物,治疗有效率100%。结论:NS患者长期服激素及免疫抑制剂,如出现全身多发脓肿,肺部感染影像学上表现为近胸膜的结节或团块状密度增高影,降钙素原不高,应考虑奴卡菌感染。确诊依赖于细菌学培养,早期诊断及合理用药是奴卡菌病治疗的关键。 Objective: Nephrotic syndrome (NS) patients with long-term administration of hormones, immunosuppressive agents may have immune dysfunction, easy secondary infection of rare pathogens, analysis and summary of NS patients with disseminated venereal disease clinical manifestations, diagnosis, treatment and Prognosis. Methods: A retrospective analysis of 9 cases of NS patients with nocardia infection admitted to the Department of Nephrology, Nanjing General Hospital of Nanjing Military Command in recent years, and its clinical characteristics were analyzed. Results: There were 3 males and 6 females with an average age of 33.6 ± 9.8 years. Nine patients had used hormones and immunosuppressive agents, when the dose of prednisone was 34.4 ± 12.6 mg / d. The median time to hormonal treatment until the onset of infection was June (2-51 months), with 6 of the 6 infections occurring within 6 months. 8 patients with fever, an average of 38.8 ℃ ± 1.0 ℃. 8 cases (8/9) had leukocytosis, 8 cases (8/8) had elevated C-reactive protein and 1 case (1/5) had mildly elevated procalcitonin. CD4 (+) T lymphocytes decreased in 4 (4/7) patients, with 3 cases <200 cells / μl. All 9 patients had pulmonary infection. Five of them showed solitary or scattered nodular or lumpy density hyperplasia. The lesions were close to the pleura and some of them were empty. Other parts involved in the skin, including 7 cases, 3 cases of thoracic cavity, 2 cases of liver abscess, brain, eye, adrenal in 1 case. Skin pus and hydrothorax culture positive rate reached 100%. Star, guinea pigs and slavicains were all found in 1 case, the other 6 cases failed to type. Seven patients underwent induction therapy with cotrimoxazole (TMP-SMX), two of which were combined and two of which were carbapenems alone. The response rate was 100%. Conclusion: NS patients with long-term hormone and immunosuppressive agents, such as the emergence of systemic multiple abscess, pulmonary infection in the performance of imaging near the pleural nodules or lumpy density increases shadow, procalcitonin is not high, should consider the slave card Infections Confirmed diagnosis depends on bacterial culture, early diagnosis and rational drug use is the key to the treatment of Nocardiosis.