单用阿昔洛韦及联合更昔洛韦对肾移植术后巨细胞病毒性肺炎的预防作用

Acyclovir alone and combined with ganciclovir in prophylaxis against cytomegalovirus pneumonia in renal transplant recipients

目的比较联合应用更昔洛韦、阿昔洛韦及单独应用阿昔洛韦预防肾移植术后巨细胞病毒性肺炎的效果。方法肾移植患者217例,男124例,女93例。年龄16～72岁,平均32岁。随机分为3组：单用组51例,术后第3天口服阿昔洛韦400 mg,3次/d,至术后3个月；联合用药组74例,术后第3天口服阿昔洛韦400 mg,3次/d至,术后3个月,术后第21天静脉滴注更昔洛韦250 mg,1次/d,持续7 d以替代口服阿昔洛韦；对照组92例未采用预防病毒治疗。比较3组间巨细胞病毒性肺炎发生率。结果217例共发生巨细胞病毒性肺炎20例,其中联合用药组4例(5.4%),单独用药组2例(3.9%),对照组14例(15.2%),用药组与对照组之间比较差异有统计学意义(P＜0.05),两用药组之间差异无统计学意义(P＞0.05)。17例(85.0%)肺炎患者经抗病毒及对症治疗治愈；3例死于呼吸衰竭。结论更昔洛韦、阿昔洛韦能显著降低。肾移植术后患者巨细胞病毒性肺炎的发生率,患者依从性较好。

Objective To compare the prophylactic efficacy of combination of ganciclovir and acyclovir or acyclovir alone against cytomegalovirus pneumonia in renal transplant recipients. Methods A total of 217 renal transplant recipient （ 124 men and 93 women ; mean age,32 years ; age range, 16 - 72 years） were divided into 3 groups randomly. In 51 cases,acyclovir was taken orally at a dose of 400 mg^3/d,from the third d to 3 months after transplantation. In 74 cases ,ganciclovir was administered at a dose of 250 mg/d intravenously from the 21st d to 27th d to replace Acyclovir. in 92 cases,no prophylaxis against cytomegalovirus pneumonia was performed. All patients were followed 3 months after transplantation. Comparison of the incidence rates of cytomegalovirus pneumonia among the 3 groups was performed using Fisher＇s exact test. Results Cytomegalovirus pneumonia developed in 20 cases in the 3 groups,including 4 cases （5.4%） in combined use group,2 cases （3.9%） in acyclovir alone group,and 14 cases （15.2%） in control group. Significant difference existed between the 2 experimental and control groups （ P 〈 0.05 ）. However, no signifi- cant difference existed between the 2 experimental groups （P 〉 0.05 ）. Of the 20 cases, 17 （ 85.0% ） were cured, and 3 died of respiratory failure. Conclusions Ganciclovir and acyclovir have prophylactic effect against cytomegalovirus pneumonia in renal transplant recipients. These 2 medications are inexpensive,and the patients have good compliance.