短疗程更昔洛韦预防儿童肝移植术后巨细胞病毒感染的疗效观察  

Efficacy of short-course ganciclovir in preventing cytomegalovirus infection after pediatric liver transplantation

作　　者：崔涛 董冲[2] 孙超[2] 王凯[2] 覃虹[2] 韩潮[2] 杨洋[2] 张复波[2] 宋卓伦 郑卫萍[2] 高伟[2] Cui Tao;Dong Chong;Sun Chao;Wang Kai;Qin Hong;Han Chao;Yang Yang;Zhang Fubo;Song Zhuolun;Zheng Weiping;Gao Wei(First Central Clinical College,Tianjin Medical Unirversity,Tianjin 300070,China;Transplantation Surgery,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学院一中心临床学院,300070 [2]天津市第一中心医院移植外科,300192

出　　处：《中华器官移植杂志》2020年第9期534-538,共5页Chinese Journal of Organ Transplantation

基　　金：天津市卫生计生委员会科技基金项目(16KG107)。

摘　　要：目的探讨儿童肝移植术后早期应用更昔洛韦静脉注射2周预防CMV感染的临床疗效。方法回顾性分析2015年1月1日至2017年12月31日天津市第一中心医院收治的404例儿童肝移植受者的临床资料,根据术后是否静脉滴注更昔洛韦预防CMV感染分为预防组235例和未预防组169例,记录两组受者术前、术中以及术后的随访资料。比较两组术后存活率、CMV感染发生率、首次CMV感染发生时间等临床指标。结果404例儿童肝移植受者术后中位随访时间为856d,CMV感染的发生率为39.1%;预防组与未预防组两组间性别、年龄、原发疾病、术前PELD评分、CHILD分级、手术时间.术中失血量、术后免疫抑制方案、排斥反应发生率等的差异均无统计学意义;两组儿童受者术后中位随访时间分别为1014d与731d;术后CMV感染发生率分别为37.4%(88/235)与41.4%(70/169),术后首次CMV感染发生平均时间分别为术后75.5d与110.2d,首次CMV感染后再次CMV感染率分别为26.1%(23/88)和18.6%(13/70),以上指标两组间差异均无统计学意义(P>0.05)。结论儿童肝移植术后早期应用更昔洛韦静脉注射2周并不能降低CMV感染的发生率,也不能延缓CMV感染的发生时间,不推荐作为儿童肝移植术后CMV感染的预防方案。Objective To explore the preventive efficacy of 2-week ganciclovir intravenous injection for CMV infection after pediatric liver transplantation(LT).Methods Clinical data were retrospectively analyzed for 404 pediatric LT recipients from January 1,2015 to December 31,2017.According to whether or not ganciclovir was intravenously administered for preventing CMV infection,they were divided into two groups of prevention(235 cases)and non-prevention(169 cases).The preoperative,intraoperative and postoperative followup data of two groups were recorded.Survival rate,incidence of CMV infection and time of initial CMV infection were compared between two groups.Results The median follow up time of 404 pediatric liver transplantation recipients was 856 days and the incidence of CMV infection 39.1%,No inter group statistical difference existed in such basic clinical data as gender,age,primary disease,preoperative PELD score,CHILD grade,operative duration,intraoperative blood loss,immunosuppressive regimen or rejection rate.The median follow-up time of two groups was 1014 and 731 days;The incidence of CMV infection 37.4%(88/235)and 41.4%(70/169);The average postoperative time of initial CMV infection 75.5 and 110,2 days;The rate of CMV re infection after initial CMV infection 26.1%(23/88)and 18.6%(13/70)respectively.No significant inter group differences existed(P>>0.05).Conclusions Early postoperative 2 week intravenous ganciclovir injection fails to reduce the incidence of CMV infection after pediatric LT,nor delay the occurrence time of CMV infection,It is not recommended as a preventive program for CMV infection after pediatric LT.

关 键 词：肝移植 儿童 巨细胞病毒 预防 

分 类 号：R726.5[医药卫生—儿科]