术前巨细胞病毒感染对肾移植的影响

Impact of preemptive cytomegalovirus infection on renal transplantation

目的探讨术前巨细胞病毒(cytomegalovirusinfection,CMV)感染对肾移植术后急性排斥反应(acuterejec tion,AR)的影响及术前预防性抗病毒治疗的意义。方法回顾性分析了116例肾移植受体的术前CMV感染和预防性抗病毒治疗情况,根据术前有无CMV感染分为感染组和非感染组,将CMV感染组肾移植受体根据有无预防性抗病毒治疗分为治疗组和非治疗组。同时检测35例正常健康者CMV结果。采用检测CMV PP65抗原诊断CMV感染。结果术前CMV感染率肾移植受体为63.8%(74/116)高于正常健康者14.3%(5/35)。术后发生CMV感染或CMV病非治疗组为5例(15.6%)高于治疗组1例(2.4%)。发生急性排斥反应的术前CMV感染组为14例(18.9%)高于非感染组2例(4.8%)。术后发生AR治疗组为4例(9.5%)低于非治疗组10例(31.3%)。结论肾移植受体术前CMV感染发生率高于正常健康人群。预防性抗病毒治疗可以降低术后CMV感染或CMV病的发生率。术前CMV感染的肾移植受体术后AR发生率高于非感染者。对术前CMV感染患者采取预防性抗病毒治疗可以降低术后AR的发生率。

Objective To investigate the effect of preemptive cytomegalovirus infection（CMV） on acute rejection （AR） and assess the value of preemptive prophylactic antivirus therapy. Methods Retrospective study of 116 transplant recipients from September 2001 to February 2005 was made. The CMV infection was diagnosed by CMV-PP65 antigen tests. According to the result of CMV-PP65 antigen, 116 transplant recipients were divided into preemptive CMV infected group and non-infected group. The preemptive CMV infected recipients were subdivided into valacyclovir-treated group and non-valacyclovir-treated group. The impact of preemptive cytomegalovirus infection on acute rejection was analyzed. At the same time, CMV-PP65 antigen in 35 healthy subjects was detected. Results Seventy-four recipients had preemptive CMV infection, and the infection rate of renal transplant recipients was higher than healthy subjects （63.8% vs 14. 3%, P 〈0. 01 ）. After operation, five recipients had CMV infection or CMV disease among the non-treatment group, which was significantly higher than that in the treatment group （ 15.6% vs 2.4%, P 〈 0. 01 ）. Fourteen recipients had AR among the preemptive CMV infected group, which was significantly higher than that in the noninfected group （ 18.9% vs 4. 8%, P 〈 0. 01 ）. After operation, 4 recipients had AR among the valacyclovir-treated group, which was significantly lower than that in the non-valacyclovir-treated group （9.5% vs 31.3%, P 〈0. 01 ）. Conclusion The CMV infection rate in renal transplant recipients is higher than that in healthy subjects. Prophylactic antivirus therapy can reduce the rate of CMV infection or CMV disease postoperatively. The rate of AR in the preemptive CMV infected group is higher than that in the noninfected group. Preemptive prophylactic antiviral treatment can reduce the rate of AR after operation.