慢性肾脏病患者应用免疫抑制剂发生巨细胞病毒感染的临床分析  

Clinical Analysis of Cytomegalovirus Infection due to Immunosuppressive Drugs Applied in Chronic Renal Disease

作　　者：方静[1] 李文歌[1] 邹古明[1] 徐志宏[1] 张聪[1] 谭昭[1] 陈文[1] 杨彦芳[1] 

机构地区：[1]中日友好医院肾内科,北京100029

出　　处：《中华医院感染学杂志》2010年第18期2771-2773,共3页Chinese Journal of Nosocomiology

摘　　要：目的通过分析慢性肾脏病患者应用免疫抑制剂后发生巨细胞病毒感染的临床特点,探讨慢性肾脏病患者如何防治巨细胞病毒感染。方法回顾性分析我院9例慢性肾脏病患者在应用免疫抑制剂治疗后,发生巨细胞病毒感染的临床表现,以及诊断和治疗方面的特点。结果 9例肾病患者均存在不同程度肾功能不全,均较大剂量应用了糖皮质激素,其中6例合用了吗替麦考酚酯、3例合用了环磷酰胺,巨细胞病毒感染发生在上述治疗的1～3月内,临床表现为肺炎5例,肝功能损害2例,血象三系减少2例。停用免疫抑制剂或减量,除1例外,均给予更昔洛韦抗病毒治疗,其中8例痊愈,1例因合并细菌和真菌感染死亡。结论对应用免疫抑制剂治疗的慢性肾脏病患者,尤其是肾功能不全的患者,应警惕合并巨细胞病毒感染的可能,如能及时诊断和治疗,多数患者预后较好。OBJECTIVE To analyze the patients of renal disease with cytomegalovirus infection after taking immunosuppressive drugs and discuss the preventive measures for the patients with cytomegalovirus infection.METHODS Totally 9 cases of renal disease,who developed cytomegalovirus infection after taking immunosuppressive drugs,were collected in this study,the clinical performance,diagnosis and treatment were retrospectively analyzed.RESULTS All of nine cases had renal insufficiency in different degree and took corticosteroids.Among which,6 cases used mycophenolate mofetil,while 3 cases used cyclophosphamide.All of the 9 cases developed the cytomegalovirus infection after taking immunosuppressive drugs within 1～3 months,among which five cases had pneumonitis,two cases with hepatitis,two cases with lower peripheral hemogram.According to individual condition,the immunosuppressive drugs were stopped or reduced,and ganciclovir was applied for treatment except for one case,8 cases were recovered and 1 case was dead in combination infection with bacteria and fungi.CONCLUSION For the patients who used immunosuppressive drugs for the treatment,especially the patients with renal insufficiency,the cytomegalovirus infection should be alerted,the prognosis will be better if the diagnosis and treatment is in time.

关 键 词：巨细胞病毒 免疫抑制剂 吗替麦考酚酯 糖皮质激素 更昔洛韦 

分 类 号：R181.32[医药卫生—流行病学]