肾移植术后巨细胞病毒感染的临床分析

Clinical analysis of cytomegalovirus infection following renal transplantation

学术背景:巨细胞病毒感染是肾移植术后常见并发症和主要死亡原因,除具有器官特异性损害外,也可增加移植物排斥危险,进一步影响移植肾的长期存活。了解巨细胞病毒感染的特点、危险因素及目前常见防治手段十分重要。目的:就肾移植术后巨细胞病毒感染的危险因素及防治进行综合分析。检索策略:应用计算机检索Pubmed数据库1987-01/2004-12有关肾移植术后巨细胞病毒感染的文章,检索词为"Kidney transplantation,CMV,infection",限定文章语言种类为英语。对资料进行初选,纳入标准:①有关肾移植术后巨细胞病毒感染病因的研究。②有关肾移植术后巨细胞病毒感染临床防治的研究。排除标准:重复研究。文献评价:共收集98篇文章,排除重复或类似研究,19篇符合要求被选为参考文献。其中5篇文章研究了肾移植术后巨细胞病毒的感染特征,6篇文章研究了巨细胞病毒感染的危险因素,8篇文章研究了巨细胞病毒感染的防治问题。资料综合:①肾移植术后巨细胞病毒感染的特征:巨细胞病毒感染是由于巨细胞大量复制达到较高的病毒载量引起,移植肾提供了复制的理想场所。②肾移植术后巨细胞病毒感染的危险因素:D+/R-是术后巨细胞病毒感染的极高危险因素;肾移植术后排斥反应、使用免疫抑制剂、肾移植手术时间均是巨细胞病毒感染的危险因素。③巨细胞病毒感染的防治:避免感染、重视术前供受双方血清检测及筛选血制品是预防巨细胞病毒感染的有效方法。结论:重视肾移植术前供受双方血清检测,慎重选择血制品是预防肾移植术后巨细胞病毒感染的有效方法。调整免疫抑制剂,选用适当抗病毒治疗方法,不仅能有效抗巨细胞病毒感染,在防止急性排斥反应和肾功能损害方面也表现出其优异特性。

BACKGROUND： Cytomegalovirus infection is the common complication and main cause of death after renal transplantation. It can result in organ specific lesions, increase the risk for graft rejection, and affect the long-term survival of transplanted kidney. Therefore, to know its characteristics, risk factors and prevention approaches is very important. OBJECTIVE： To comprehensively analyze the risk factors and prevention of cytomegalovirus infection following renal transplantation. RETRIEVAL STRATEGY： A computer-based online search of Pubmed was undertaken to identify articles published in English from January 1987 to December 2004 with the keywords of ＂kidney transplantation, CMV, infection＂. Articles about ①the pathogenesis of cytomegalovirus infection after renal transplantation and ②the clinical prevention and cure of cytomegalovirus infection after renal transplantation were selected. Repetitive studies were excluded. LITERATURE EVALUATION： Ninety-eight articles were collected. After the repetitive studies and identical researches were eliminated, 19 articles accorded with the inclusive criteria were selected as references including 5 about the characters of cytomegalovirus infection, 6 about the risk factors for cytomegalovirus infection, and 8 about the prevention of cytomegalovirus infection. DATA SYNTHESIS： ①Cytomegalovirus infection is caused by high virus load after much giant cell reproduction, and transplanted kidney just provides a ideal place for the reproduction. ②D^＋/R^- is an important risk factor for cytomegalovirus infection following transplantation. ③To avoid infection, pay attention to serum detection of donor and recipient before operation, and blood product screening is the effective method to prevent cytomegalovirus infection. CONCLUSION： Careful serum detection of donor and recipient before operation, and blood product screening are effective approaches to prevent cytomegalovirus infection after renal transplantation. To adjust immunosuppressant and select antiviral therapy can effectively resist cytomegalovirus infection, and prevent acute rejection and renal function lesions.