婴幼儿肝移植术后麻疹病毒感染四例报告  

Measles in pediatric liver transplant recipients： A report of 4 cases

作　　者：刘颖[1] 孙丽莹[1] 朱志军[1] 魏林[1] 曲伟[1] 曾志贵[1] 

机构地区：[1]首都医科大学附属北京友谊医院,100050

出　　处：《中华器官移植杂志》2015年第1期20-23,共4页Chinese Journal of Organ Transplantation

摘　　要：目的总结和探讨儿童肝移植术后麻疹病毒感染的发病、治疗及转归。方法自2013年6月至2014年4月共行儿童肝移植56例，其中4例术后发生麻疹病毒感染，发生率7．1％（4／56）。回顾性分析4例患儿的临床资料。4例患儿均因“胆道闭锁、胆汁淤积性肝硬化”接受肝移植，均采用以他克莫司为基础的免疫抑制方案，术前4例患儿均因原发肝脏疾病未接种麻疹病毒疫苗。所有4例患儿诊断麻疹病毒感染前（出疹前）均有咳嗽、流涕、畏光等典型麻疹病毒感染潜伏期表现；所有患儿出疹前均有发热，体温大于38．5℃，发热至出疹的平均时间约为4d，患儿出疹顺序大致先从耳后、发际渐及颜面部、颈部、躯干及四肢，4例患儿均可见口腔Koplik斑，行血清麻疹抗体IgM检查以明确诊断。4例患儿均无典型的发热消退后开始出现皮疹表现。治疗措施主要包括减少免疫抑制剂用量或停用、静脉输注人免疫球蛋白以及联合抗感染治疗等。结果4例患儿在肝移植术后发生麻疹病毒感染时临床表现和症状较重，其中3例合并肺炎，1例合并喉炎；2例进展为麻疹重症肺炎，需呼吸机辅助呼吸；经积极治疗后3例患儿痊愈，1例因呼吸功能衰竭而死亡。结论儿童肝移植术后发生麻疹病毒感染合并重症肺炎风险高，且病情进展迅速，应早期诊断，及时泊疗，并重视对并发症的处理。Objective To summarize and explore the clinical characteristics, treatment and outcome of measles in pediatric liver transplant recipients. Method A total of 56 recipients underwent pediatric liver transplantation from June 2013 to April 2014, and 4 recipients suffered from measles postqiver transplantation with the incidence being 7.1%. The data of 4 recipients were retrospectively analyzed. All of the 4 cases were subjected to liver transplantation at our center for biliary atresia and cholestasis liver cirrhosis. All the patients received the combined immunosuppressive regimen on the basis of tacrolimus. All the patients did not accept the immunization with measles vaccine because of the primary liver diseases. All the cases presented the clinical manifestations of cough, high fever （T 〉38. 5℃） and conjunctiva congestion before the rashes came out. Maculopapular rashes appeared about 4 days after the fever. The rashes first appeared from the skine post aurem, face, neck, and then spread to trunk and extremities. Koplik＇s spots on the buccal mucosa were observed in all the 4 cases. The serological test of IgM antibodies to measles was done. The treatment was adjusted as soon as the diagnosis of measles was clear. Immunosuppressants were decreased or stopped, intravenous immunoglobulin （IVIG） combined with anti-infection drugs was given. Result The clinical manifestation of measles in pediatric liver transplant recipients was serious. There were 3 cases complicated with pneumonia, and one case with laryngitis. Two cases presented severe measles pneumonia and developed into severe respiratory failure requiring mechanical ventilation. Three cases recovered from the therapy and 1 case died of respiratory failure. Conclusion Pediatric liver transplant recipients who suffered from measles are at high risk of severe pneumonia. Measles pneumonitis is frequently fatal in immunocompromised pediatric patients. The treatment shoule be given as soon as possible.

关 键 词：儿童 肝移植 麻疹 

分 类 号：R726.5[医药卫生—儿科]