肾移植术后巨细胞病毒性肺炎的影像学特点及治疗对策

Imaging feature and treating strategy of cytomegaloviral pneumonia after renal transplantation

目的探讨肾移植术后患者合并巨细胞病毒(CMV)肺炎的影像学特点及治疗对策。方法对14例肾移植术后合并CMV肺炎患者的影像学特点及临床资料进行回顾性分析。结果14例CMV肺炎患者X线表现为无明显肺部改变4例,其余10例改变早期为两肺野纹理增强、模糊不清、呈毛玻璃样密度增高。CT主要表现均为毛玻璃阴影,其中9例肺内出现小结节病灶,8例肺内散在分布斑片样病灶,7例出现小叶间隔增厚。对14例CMV肺炎患者采取综合治疗方案,治愈12例,死亡2例。结论肾移植术后患者早期出现上述肺部改变,应综合分析并考虑CMV肺炎的可能性并及时采用以更昔洛韦为主的综合治疗方案。

Objective To discuss the imaging feature and treating strategy of cytomegaloviral pneumonia after renal transplantation. Methods Clinical, laboratory data, chest X ray films and CT findings, treating measures of 14 eases with eytomegaloviral pneumonia after renal transplantation were retrospectively analyzed. Results Among 14 cases,the chest X ray films demonstrated normal in 4 cases; augmented, obscure puhnonary markings and ground glass like shadows were displayed in both lungs in early stage in rest 10 cases; On CT, the main CT appearance contained diffuse ground glass-like shadows among 14 cases,small nodules in 9 cases,flake consolidation in 8 cases,thickened interlobular septum in 7 cases and so on were seen. 12 cases got healing well and 2 cases ended in death by means of combined therapeutic regimens. Conclusion Appearance that pulmonary characteristics abovementioned in earlier period combining with the clinical data can be regarded as a useful diagnosing indicator of cytomegalovirus pneumonitis after renal transplantation. Moreover, combined therapeutic regimens will be put into practice in time by the most of Ganciclovir.