肾移植术后巨细胞病毒性重症肺炎的发病特点及其诊治策略

Clinical Characteristics and Diagnostic and Therapeutic Strategies of Severe Cytomegaloviral Pneumonia after Kidney Transplantation

目的总结肾移植术后巨细胞病毒性（CMV）重症肺炎的发病特点和诊治对策。方法凹顾性分析6例肾移植术后CMV重症肺炎患者的发病经过、入院前后的临床表现、各种辅助检查、治疗过程和预后的相关临床资料。结果6例患者发病特点相似，包括：术后1～3月发病；主要症状为发热、咳嗽，基本无痰，发热早期憋气症状不明显；外周血白细胞正常或偏低，血清CMVpp65最后均为阳性；发热7～10d后，肺部出现炎性浸润灶，发展迅速，以间质性病变为主；肺部感染加重时，肾功能随之恶化；6例患者均经历了多种抗菌药物、糖皮质激素和机械通气等治疗；第3～6例患者CMV病原学诊断较早，并进行了较长时间的抗CMV病毒和激素维持治疗，最后存活，前2例患者死亡，死亡原因为顽固性低氧血症和急性肾功能衰竭。结论CMV重症肺炎具有相似的发病特点；早期明确病原学诊断、坚持抗CMV病毒和糖皮质激素维持治疗是成功治疗的关键。

OBJECTIVE To summarize the clinical characteristics, diagnositic and therapeutic strategies of severe cytomegaloviral （CMV） pneumonia after kidney transplantation. METHODS To analyze retrospectively pertinent clinical information of 6 cases of severe cytomegaloviral pneumonia after kidney transplantation, including developing process of disease, clinical manifestation of pre-and post-hospitalization ,various assistant examination, therapeutic procedures and prognosis. RESULTS 6 cases had similar characters of episode as follows： CMV pneumonia occurred after 1 ~ 3 months after kidney transplantation. Major clinical symptoms included fever, coughing,few sputum without obvious manifestation of breathholding. Peripheral white blood cell was normal or less than normal range, serum CMVpp65 was finally positive during hospital stay. Radiological image of the lung presented inflammatory infiltration and obvious interstitial lesion after 7 - 10 days of fever, which went worse rapidly. Renal function descended with deterioration of pulmonary infection. All of patients had been treated with multiple antibiotics,glucocorticoid and mechanical ventilation, Etiological diagnosis of the 3th- 6th cases were earlier than 1th-2th cases , the 3th-6th cases who finally survived were treated with longer and higher doses of antivirus and glucocorticoid, than 1th-2th cases who died of refractory hypoxemia and acute renal failure during hospital stay. CONCLUSIONS Severe cytomegaloviral pneumonia had similar clinical characteristics of episode. early diagnosis of etiology, continuous application of antivirus and glucocorticoid were crucial for Severe cytomegaloviral pneumonia after kidney transplantation.