肾移植术后巨细胞病毒肺炎的临床研究

The clinical study on CMV pneumonia after kidney transplantation(analysis of 34 cases)

目的:探讨肾移植术后巨细胞病毒(CMV)肺炎的临床特点及诊疗对策。方法:回顾34例肾移植术后CMV肺炎患者临床资料,总结临床特点和治疗措施。结果:34例患者,治愈30例,占88.24%,死亡4例(其中放弃治疗后死亡2例)。治愈患者除1例出现移植肾排斥反应外,其余功能均正常。高剂量更昔洛韦联用糖皮质激素组,在需使用呼吸机几率和死亡率方面均低于未使用糖皮质激素的常规剂量更昔洛韦组(P=0.045和0.010)。结论:早期及时诊断,适时适量应用激素,足剂量长疗程抗病毒治疗,及早进行高流量给氧或辅助呼吸等综合治疗是提高治愈率、降低病死率的关键。

Objective： To investigate the clinical features, early diagnosis and therapy of CMV pneumonia after kidney transplantation. Method： A retrospective analysis of 34 patients after kidney transplantation with CMV pneumonia was undertaken. Result： 30 cases recovered and 4 cases died （including 2 cases who discontinued medication）. The cure rate was 88.24%, and the grafts＇ function of the survived patients maintained normal level except 1 case with graft rejection. The group treated with large dose of ganciclovir and glucocorticoid had lower rate of the need for respiratory machine and death than that treated with routine dose of ganciclovir and no glucocorticoid. Conclusion：The key to higher recovery rate and lower death rate included the early diagnosis, adequate dose of steroid and immunosuppressants, sufficiently antiviral therapy, high flow oxygen and assisted mechanical ventilation as soon as possible.