21例肾脏疾病患者免疫抑制剂治疗后继发巨细胞病毒肺炎的救治  

Effects of immunosuppressor against kidney disease in treatment of 21 patients with cytomegalovirus pneumonia

作　　者：梁艳冰[1] 马中富[1] 黄锋先[2] 吴培根[2] 李幼姬[2] 许元文[2] 

机构地区：[1]中山大学附属第一医院普内科,广州510080 [2]中山大学附属第一医院肾内科,广州510080

出　　处：《中华急诊医学杂志》2007年第11期1184-1186,共3页Chinese Journal of Emergency Medicine

基　　金：广东省卫生厅资助项目(A2004186)

摘　　要：目的观察肾脏疾病免疫抑制剂治疗后继发巨细胞病毒(cMV)肺炎的临床特征、治疗和转归。方法在1999年6月至2006年12月在中山大学附属第一医院接受免疫抑制剂治疗的肾脏疾病患者中,采用免疫细胞化学法对外周血和(或)支气管肺泡灌洗液白细胞进行CMV抗原检测,同时结合临床表现,将21例诊断为CMV肺炎,并给予丙氧鸟苷5～10 mg·kg^(-1)·d^(-1)静脉滴注,停用免疫抑制剂治疗。现回顾性分析其临床特征和预后。结果21例患者发生CMV肺炎前均使用了皮质激素,13例为甲基泼尼松冲击治疗,平均总剂量为(3.2±0.6)g,15例接受环磷酰胺治疗,平均总剂量为(3.8±1.3)g,免疫抑制剂使用到诊断CMV肺炎的时间中位数为25(13～92)d;21例患者均有发热、干咳、气促气喘,X线胸片均示间质性肺炎,19例伴低氧血症,11例支气管灌洗液白细胞CMV抗原阳性。9例患者存活,12例(57.2%)死亡。然而丙氧鸟苷平均疗程为(26.2±6.3)d。结论CMV肺炎是接受免疫抑制剂治疗的肾脏疾病患者的严重并发症,病死率高,然而丙氧鸟苷是其有效治疗药物。Objective To study the clinical feature, treatment, and prognosis of the cytomegalovirus （CMV） pneumonia patients treated with against kidney disease. Method The patients received immunosuppressor against kidney disease in The First Affiliated Hospital of Sun Yat-sen University from June 1999 to December 2006. CMV antigen of leucocyte in the peripheral blood and/or bronchoalveolar lavage fluid of these patients were detected with immunocytochemical methods, and 21 patients were found suffering from CMV pneumonia. The 21 patients were introvenously injected with ganciclovir 5 - 10 mg/ （kg·d ）, and the immunosuppressive agent treatment suspended. Their chnical feature and prognosis were retrospectively analyzed. Results The 21 patients received corticosteroids before CMV pneumonia contracted, of them, 13 patients had been intensively treated with Methyllpredniselone with mean total dose （3.2 ± 0.6） g. Of them, 15 had been treated with cyclophosphamide with mean total dose （3.8 ± 1.3） g. The median time from the beginning of using immunosuppressor to the onset of CMV pneumonia was 25 （13 - 92 ） days. All patients had fever, cough, shortness of breath and X-ray showed interstitial pneumonia, of them, 19 patients developed hypoxemia, and 11 patients＇ CMV antigen was positive in the leucocyte from bronchial lavage fluid. The result showed 9 patients survived and 12 died. The average duration of treatment with ganciclovir was （26.2 ± 6.3） days. Conclusions CMV pneumonia is a serious complication in patients who were treated with immunosuppressor against kidney disease. The mortahty is high. Ganciclovir is a medicine of choice to treat CMV pneumonia.

关 键 词：肾脏疾病 巨细胞病毒 肺炎 免疫抑制剂 治疗 

分 类 号：R692[医药卫生—泌尿科学] R563.1[医药卫生—外科学]