肾移植术后巨细胞病毒性肺炎56例临床分析

Clinical Analysis of Cytomegalovirus Pneumonia in 56 Patients after Kidney Transplantation

目的:回顾分析肾移植术后巨细胞病毒性肺炎(CMV)的临床特点,探讨预防和诊治巨细胞病毒肺炎的方法,提高人肾存活率。方法:对2000年1月～2007年12月肾移植术后发生的56例CMV肺炎患者的临床特点及诊疗措施进行回顾性分析。结果:56例患者,肺炎发生在术后6个月以内37例,28例患者表现为急性呼吸窘迫综合征,经抗病毒等综合治疗后39例患者治愈,人肾存活,17例死亡,其中12例死于呼吸功能衰竭,5例死于严重混合感染。平均住院时间32天。结论:由于CMV肺炎病情凶险,强调早期预防、早期诊断及早期应用抗CMV药物等综合治疗方法,针对不同的患者采取不同的诊疗策略,适当调整免疫抑制方案、改善肺功能及加强支持治疗均能有效的促进病情的恢复。

Objective：To investigate the character of cytomegalovirus （CMV） pneumonia after kidney transplantation, to discuss the precaution, diagnosis and treatment of CMV pneumonia, and to improve the survival rate of the patients and their kidneys. Methods： 56 recipients of kidney transplantation between Jan. 2000 and Dec. 2007 were diagnosed as CMV pneumonia. The clinical characteristics and treatment measures of the patients were reviewed and retrospectively analyzed. Results： Among the 56 patients, 37 cases occurred CMV pneumonia within 6 months after renal transplantation, 28 patients presented signs of acute respiratory distress syndrome. After the antivirus treatment etc. , 39 patients recovered, all patients and their kidneys were survive. 17 patients died, 12 cases for respiratory function failure and 5 cases for mixed infection. The mean hospital day was 32 days. Conclusions：CMV infection is a mortal serious complication after renal transplantation. We emphasize the early stage precaution, diagnosis and comprehensive treatment such as anti-CMV drug treatment therapy. Use different strategy to treat the different kinds of situation. Withdrawal of immunosuppressant drugs, improve the lung function and strengthen the support treatment can promote the recovery.