早期治疗方案在防治肾移植术后CMV疾病中的应用  

Preemptive therapy for prevention and treatment of cytomegalovirus disease after renal transplantation

作　　者：田晓辉[1] 薛武军[1] 丁小明[1] 燕航[1] 何晓利[1] 

机构地区：[1]西安交通大学第一医院肾移植科,陕西西安710061

出　　处：《第四军医大学学报》2005年第18期1695-1697,共3页Journal of the Fourth Military Medical University

基　　金：陕西省卫生厅科学研究基金资助项目(97073)

摘　　要：目的:比较早期治疗与对所有患者进行预防性用药两种方案的临床效果.方法:将尸肾移植后患者80例分为两组:①早期治疗组(n=40),即在术后若监测到CMVPP65抗原血症阳性,则给予更昔洛韦(250mg/d)治疗,直至抗原血症转阴;②对照组(n=40),所有患者从移植后第3周开始均给予更昔洛韦(250mg/d)治疗,持续2wk,随访时间3mo,观察两组对CMV疾病的预防效果.结果:①早期治疗组和对照组在CMV疾病发病率、CMV活动性感染率、CMV疾病复发率、CMV相关死亡率以及更昔洛韦副作用等方面无显著性差异,但前者的平均疗程(8.5±3.2)d较后者(14.0±0.0)d缩短.②早期治疗组15例高危患者,12例接受早期治疗,发生CMV疾病2例,均得到有效治疗.结论:CMVPP65抗原血症指导的早期治疗能有效的预防CMV疾病的发生和保护高危人群,缩短了预防疗程.AIM： To evaluate the efficacy and cost-effectiveness of preemptive therapy guided by cytomegalovirus （ CMV ）-PP65 antigenemia and prophylactic therapy. METHODS： Eighty cases who had undergone renal transplantation were randomly divided into 2 groups： ① pre-emptive therapy group （ n = 40）, who were given ganciclovir （GCV, 250 mg/d） once at least 1 CMV-PP65 positive cell per 2.0 × 10^5 PBL （peripheral blood leucocyte） till the anti- genemia became negative. ② Control group （ n =407, who were given universal two-week-prophylaxis with GCV （250 mg/d） beginning at the 3rd week after transplantation. A 3month follow-up was conducted and the efficacy and costeffectiveness of the 2 groups were compared. RESULTS： There was no statistical difference between preemptive therapy group and control group in the incidence of CMV disease, CMV active infection, relapse of CMV disease, CMV-related mortality and side-effects of ganciclovir. But the course of treatment in the former was shorter than that in the latter C（8.5±3.2）d vs （14.0±0.0）dl, Twelve of the 15 high-risk cases in the preemptive group received preemptive therapy, of whom 2 cases developed CMV disease but were cured. CONCLUSION： Preemptive therapy with ganciclovir, a more selective and shorter course of treatment, is as safe and effective as universal prophylaxis in preventing CMV disease and protecting high-risk cases in renal transplant recipients.

关 键 词：肾移植 巨细胞病毒 巨细胞病毒感染 早期治疗 

分 类 号：R617[医药卫生—外科学]