器官移植受体巨细胞病毒肺炎的临床观察

Clinical observation on pulmonary cytomegalovirus infection after organ transplantation

目的探讨器官移植受者巨细胞病毒(CMV)肺炎的发生率、临床特点及诊治措施。方法对302例器官移植后发生CMV肺炎的37例病人临床资料进行回顾性分析。结果肝移植79例无一例发病;肾移植后CMV肺炎发病率为17.6%(22/125),病死率为36.4%(8/22);造血干细胞移植(HSCT)后两者分别为15.3%(15/98)及33.3%(5/15)。结论CMV肺炎是器官移植受体常见的严重感染并发症,发病率以肾移植及HSCT后为高。CMV肺炎病情进展快,病死率高。及早应用抗病毒药物、调整免疫抑制剂方案、及时辅助呼吸等综合疗法有效。

Objective To explore the incidence, clinical characteristics and treatment of pulmonary cytomegalovirus （CMV） infection after organ transplantation. Methods A retrospective analysis was made on 37 severe CMV pneumonia cases in 302 organ allograft recipients. Results None of 79 the orthotopic liver transplantation patients developed CMV pneumonia. Of 125 patients underwent renal transplantation, 22 recipients （17.6%） had CMV pneumonia with a mortality of 36.4 % （8/22）. Of 98 recipients of hematopoietic stem cell transplantation（HSCT）, CMV pneumonia was diagnosed in 15 patients （15.3%） with a mortality of 33.3% （5/15）. Conclusion After organ transplantation CMV pneumonia is a severe complication, which is more frequently seen after renal transplantation and HSCT. CMV pneumonia is developing quickly with a high mortality. Attention shoud be paid to the early diagnosis and combined therapy using ganciclovia, adjusting the dosage of immunosuppressants,correcting hypoxia and the supportive therapy.