肾移植术后带状疱疹的诊断与治疗

Diagnosis and treatment of herpes zuster in renal transplant recipients

目的:探讨肾移植术后并发带状疱疹的诊治方法。方法:回顾性分析23例肾移植术后并发水痘-带状疱疹病毒(VZV)感染患者的临床资料。结果:肾移植患者并发VZV感染多发生在术后1～2年,根据患者临床表现及体征即可诊断带状疱疹,23例患者在发生VZV感染后均根据血环孢素A(CsA)浓度谷值和峰值适当减少CsA用量,或调整免疫抑制剂联合用药方案。15例采用阿昔洛韦1200mg/d口服10～14天,治疗有效;另8例阿昔洛韦治疗效果不明显,改用更昔洛韦,剂量为500mg/d静脉滴注7～14天,治疗有效。所有患者在抗VZV感染的同时均使用抗生素,以防止合并细菌感染,并给予止痛、神经封闭等综合治疗。本组治疗总有效率为100%(23/23)。结论:肾移植术后VZV感染多发,诊断并不困难,治疗上合理用药非常重要,并相应调整免疫抑制治疗方案,阿昔洛韦和更昔洛韦对VZV感染有较好的疗效。

Objective：To evaluate the methods of diagnosis and treatment of Herpes Zoster（HZ）in renal transplant recipients.Methods ： Di- agnosis and treatment of 23 cases of varicella-zoster virus （VZV） infaction in renal transplant recipients were reviewed.Results：Herpes Zoster usually occurredl-2 years after renal transplantation.It could be diagnosed by symptom and physical examination.The dose of CsA and other immunosuppressants were adjusted according to the concentration of CsA after diagnosis. It was effective to use acyclovir （1200mg/d） in 15 patients and to use ganciclovir （500 mg/d ）in other 8 patients. Antibiotics were used in all patients to avoid bacterial infection.The total effective rate 100% （23/23）.Conclusion： VZV was a common disease after renal was transplantation.Early diagnosis, prompt treatment and rational adjustment of the immunosuppressant were essential.Both acyclovir and ganciclovir are effective for the treatment of HZ.