肾移植术后严重巨细胞病毒感染治疗经验

The efficacy of Ganciclovir in the treatment of severe CMV infection in renal graft recipients

目的：总结８例尸体肾移植术后严重巨细胞病毒（ＣＭＶ）感染的治疗经验。方法：通过检测ＣＭＶ┐ＩｇＭ或（和）检测血中ＣＭＶ┐ＤＮＡ（ＰＣＲ法），结合临床症状及胸片确立诊断。以丙氧鸟苷治疗，配合静脉滴注大剂量丙种球蛋白，适当减少免疫抑制剂，治疗／预防二重感染，加强营养等综合治疗。结果：治愈６例，死亡２例。结论：严重ＣＭＶ感染致死率高。

BACKGROUND Eight renal graft recipients with severe CMV infection were included. Diagnosis of CMV infection was made based on the clinical picture and laboratory examination of serum CMV IgM and/or CMV DNA. Ganciclovir was given (5mg/kg/time, 2 time/day for at least 14 days, and a reduction was made for patients with renal insufficiency) to those with severe CMV infection. Other treatment included reduction of immunosuppresive agent, high dose immunoglobulin intravenously, preventing or treating superinfections and nutritional support. RESULTS The clinical pictures of severe CMV infection included fever, cough(little or no sputum), exertional dyspnea, or severe hypoxemia with interstitial pneumonia changes radiologically in those patients. After the treatment, six patients got complete remission, 2 patients died, with a survival rate of 75% in this group of patients. Side effects observed in ganciclovir treatment included neutropenia in 3 patients and thrombopenia in 1 patient. These effects disappeared soon after withdrawing of ganciclovir. CONCLUSION 〖WTBZ] Ganciclovir is an effective drug in anti CMV infection in renal graft recipients. Better results could be achieved when ganciclovir was given with the supportive treatment.