肝移植术后巨细胞病毒感染的特点  

Characteristics of cytomegalovirus infection following liver transplantation

作　　者：杜隽铭[1] 全志伟[1] 王健东[1] 朱健[1] 沈军[1] 

机构地区：[1]上海交通大学医学院附属新华医院普外科,上海市200092

出　　处：《中国组织工程研究与临床康复》2007年第8期1556-1557,F0003,共3页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的：观察肝移植受者术后巨细胞病毒的感染情况及干预效果。方法：选择2002-07/2005-07在上海交通大学医学院附属新华医院行同种异体原位肝移植手术的患者20例,均知情同意。术后1个月内每周检测1次巨细胞病毒血清抗体,术后2-6个月每个月检测1次巨细胞病毒血清抗体,以后有感染症状时检测巨细胞病毒血清抗体。所有患者术后给予更昔洛韦0.5g静脉滴注,2次/d,维持2周;以后用阿昔洛韦800mg/d口服,维持3个月进行预防性治疗。所有患者术后采用三联免疫抑制治疗,根据术后血药浓度及肝功能改变调整免疫抑制药物用量。采用ELISA法检测患者血中巨细胞病毒抗体-巨细胞病毒IgG、巨细胞病毒IgM。巨细胞病毒血清抗体阳性者诊断为巨细胞病毒感染;巨细胞病毒血清抗体阳性合并组织器官受累者诊断为巨细胞病毒病。结果：20例患者全部进入结果分析,无脱落。20例患者中3例血中巨细胞病毒IgM转化为阳性,为巨细胞病毒感染,其中2例伴有呼吸系统症状及影像学改变,诊断为巨细胞病毒性肺炎。3例巨细胞病毒感染病例中2例治愈,1例死于呼吸衰竭。巨细胞病毒感染率为15%（3/20）,巨细胞病毒肺炎发病率为10%（2/20）,病死率为5%（1/20）。结论：肝移植术后进行巨细胞病毒感染的预防性治疗,定时监测尽早发现巨细胞病毒感染,及时治疗,阻断其向巨细胞病毒病演变是降低巨细胞病毒病死率的有效方法。AIM：To explore the interventional effect of cytomegalovirus （CMV） infection after liver transplantation. METHODS： Twenty patients underwent allogenic orthotopic liver transplantation from July 2002 to July 2005 were selected from Xinhua Hospital Affiliated to the Medical College of Shanghai Jiao Tong University, and all subjects knew and agreed with the items. CMV antibody was inspected once a week within the first month postoperation, and it was also inspected while infection was found. All subjects were intravenously administrated with 0.5 g of Ganciclovir after the operation twice a day for 2 continuous weeks, and then given prophylactic treatment by orally taking 800 mg of Ganciclovir per day for 3 months. Triple immunosuppressive therapy was performed in all subjects after the surgery, and the dose of immunosuppressive drugs was adjusted according to postoperative concentration of carbinoxamine compound drops and the changes of hepatic function. ELISA was adopted to detect the CMV IgG and CMV IgM in serum of patients. Patients positive in CMV antibody were diagnosed as CMV infection, and patients positive in CMV antibody affected tissues and organs were diagnosed as CMV. RESULTS： A total of 20 patients were involved in the analysis of results, and no one withdrew from the study, including 3 patients, who were positive in CMV IgM, infected by CMV and 2 developed into CMV pneumonia proved by symptoms in respiratory system and changes in imageology. Two of three patients with CMV infection recovered after antivirel therapy while one died of respiratory failure. The total infective rate of CMV infection was 15% （3/20）, and the incidence of CMV pneumonia was 10% （2/20）, and the mortality was 5% （1/20）. CONCLUSION： Prophylactic treatment of CMV infection is performed after liver transplantation, and regular detection helps to discover CMV infection. In time treatment and intervention of the development of CMV is effective in reducing the mortality of CMV infection.

关 键 词：肝移植 巨细胞病毒感染/治疗 

分 类 号：R714.251[医药卫生—妇产科学]