糖皮质激素治疗肾移植术后巨细胞病毒肺炎

The role of glucocorticoid in treating cytomegalovirus pneumonia following renal transplantation

目的探讨糖皮质激素在治疗肾移植术后巨细胞病毒(CMV)肺炎中的作用。方法75例患者肾移植术后并发CMV肺炎,3例CMV肺炎发生于肾移植术后1个月内,64例发生于2～6个月,8例发生于6个月以后。诊断为CMV肺炎后,均采取抗病毒为主的综合治疗措施,如停用环孢素A(或他克莫司)和霉酚酸酯等免疫抑制剂;给予更昔洛韦等抗病毒药物;选用广谱抗生素积极预防和治疗二重感染;对低氧血症明显的患者,给予高频吸氧,甚至呼吸机辅助通气;加强支持治疗。其中47例加用糖皮质激素治疗(使用激素组),给予甲泼尼龙40～80 mg静脉注射,每天1～2次,体温下降后3～5 d逐渐减量,根据病情调整剂量,待病情缓解或X线胸片好转后逐渐减量至停用,平均用药时间在21～28 d;另28例不用糖皮质激素(未用激素组)。比较两组的治疗效果及患者存活情况。结果使用激素组的47例,治愈40例(85.1%,40/47),死亡7例(14.9%,7/47),未用激素组的28例,治愈17例(60.7%,17/28)。死亡11例(39.3%,11/28),两组比较,差异有统计学意义(P<0.05)。使用激素组治疗第1天患者的体温即有明显下降,未使用激素组在治疗第3天体温才有显著下降,两组体温恢复正常所需时间的差异有统计学意义(P<0.01)。使用激素组治疗第1天患者的呼吸频率即较治疗前明显下降(P<0.05),未使用激素组在治疗第3天呼吸频率才有显著下降,治疗3 d时,两组患者呼吸频率的差异有统计学意义(P<0.05)。结论肾移植后的CMV肺炎采用糖皮质激素治疗,可明显改善发热、呼吸急促等相关症状,提高治愈率,降低患者的死亡率。

Objective To study the role of glucocorticoid （GC） in treating patients with cyto- megalovirus （CMV） pneumonia following renal transplantation. Methods There were 75 cases CMV pneumonia following renal transplantation during one month （3 cases）, 2-6 months （64 cases） and more than 6 months （8 cases）. All patients were subjected to the comprehensive treatments including anti-virus therapy. In 47 cases, GC was given （GC group）, and in the rest 28 cases, GC was not administered （non-GC group）. Results In GC group, 40 cases （85. 1%） were cured and there were 7 deaths （14.9%）. In non-GC group, 17 cases （60.7%） were cured and there were 11 deaths （39.3%）. There was significant difference between two groups （P〈0.05）. In GC group, body temperature was reduced on the day 1 after treatment, while on the day 3 after treatment in the non- GC group （P〈0.01）. In GC group, the respiratory rate was significantly decreased on the day 1 after treatment as compared with that before treatment, while on the day 3 after treatment in non-C,C group （P〈0.05）. Conclusion GC treatment for the patients with CMV pneumonia following renal transplantation could obviously improve the symptoms, increase the curative rate and reduce the mortality.