肾移植术后带状疱疹的诊治  

Diagnosis and treatment of Herpes Zoster in renal transplant recipients

作　　者：宋宁宏[1] 宋宁静[2] 张炜[1] 顾民[1] 冯宁翰[1] 钱立新[1] 华立新[1] 殷长军[1] 徐正铨[1] 眭元庚[1] 唐宁枫[2] 吴宏飞[1] 

机构地区：[1]南京医科大学第一附属医院泌尿外科,210029 [2]中国医学科学院中国协和医科大学皮肤病研究所

出　　处：《中华器官移植杂志》2006年第1期8-10,共3页Chinese Journal of Organ Transplantation

摘　　要：目的探讨肾移植术后并发带状疱疹的诊治方法。方法回顾性分析63例肾移植术后并发水痘带状疱疹病毒(VZV)感染患者的临床资料。结果肾移植患者并发VZV感染多发生在术后1～2年,根据患者的临床表现及体征即可诊断带状疱疹,必要时可取水疱液检查;63例患者在发生VZV感染后均根据血环孢素A(CsA)浓度谷值和峰值适当减少CsA用量,或调整免疫抑制剂联合用药方案。53例采用阿昔洛韦5～10mg·kg-1·d-1静脉滴注4～10d,治疗有效;另10例阿昔洛韦治疗效果不明显,6例改用更昔洛韦,4例加用更昔洛韦,剂量为5～6mg·kg-1·d-1,其中9例治愈,1例死于巨细胞病毒感染所致的呼吸衰竭。所有患者在抗VZV感染的同时均使用抗生素,以防止合并细菌感染,并给予止痛、神经封闭以及生物反馈等综合治疗。本组治疗的总有效率为98.4%(62/63)。结论肾移植术后VZV感染多发,诊断并不困难,治疗上合理用药非常重要,并相应调整免疫抑制治疗方案;阿昔洛韦和更昔洛韦对VZV感染有较好的疗效。Objective To evaluate the methods of diagnosis and treatment of Herpes Zoster （HZ） in renal transplant recipients. Methods Diagnosis and treatment of 63 cases of Herpes Zoster in renal transplant recipients were reviewed. Results Herpes Zoster usually occurred 1-2 years afterrenal transplantation. It could be diagnosed by symptom and physical examination. The dose of CsA and other immunosuppressants were adjusted according to the concentration of CsA after diagnosis. Acyclovir （5-10mg·kg^-1·d^-1） was used in all the 63 patients, and was effective in 53 cases. Ganciclovir （5-6 mg·kg^-1·d^-1） was used in other 10 patients. Among them, 6 took ganciclovir only and the remaining 4 ganciclovir combined with acyclovir. Nine of them were cured while the other 1 with cytomegalovirus （CMV） infection finally died. Antibiotics were used in all patients to avoid bacterial infection. The total effective rate was 98. 4 %（62/63）. Conclusion VZV was a common disease after renal transplantation. Early diagnosis, prompt treatment and rational adjustment of the immunosuppressant were essential. Both acyclovir and ganciclovir are effective for the treatment of HZ.

关 键 词：肾移植 疱疹 带状 诊断 治疗结果 

分 类 号：R699.2[医药卫生—泌尿科学]