肾移植后重症巨细胞病毒性胃肠炎的临床诊治:3例报告

Clinical treatment of severe gastrointestinal cytomegalovirus infection following renal transplantation in 3 cases

为探讨肾移植后重症巨细胞病毒性胃肠炎的诊断要点和有效治疗措施,回顾性总结2001-03/2008-05广州医学院第二附属医院收治的3例肾移植后重症巨细胞病毒胃肠炎患者的临床资料。用药:抗病毒药物:膦甲酸钠50～60mg/kg,静脉滴注,2次/d,用药在2周以上;更昔洛韦5mg/kg,静脉滴注,2次/d,持续用药在2周以上;大剂量丙种球蛋白:应用人血丙种球蛋白200～500mg/(kg·d),连续静滴14d;预防性应用小剂量广谱抗生素,避免继发性感染;应用调节胃肠道菌群的药物和止泻药物:双歧杆菌活菌制剂、蒙脱石散剂、盐酸洛哌丁胺胶囊等;调节免疫抑制剂的用量及对症支持疗法。经治疗2例治愈,1例放弃治疗。结果提示对肾移植后重症病毒性胃肠炎及时正确诊断、合理用药并调节免疫抑制剂的用量是治疗的关键。

The paper wants to explore the diagnosis basis and therapy methods for severe gastrointestinal cytomegalovirus （CMV） infection following renal transplantation. We retrospectively analyzed the clinical materials of the 3 patients who had experienced severe gastrointestinal CMV infection after renal transplantation in the Second Affiliated Hospital of Guangzhou Medical College from March 2001 to May 2008. Medication： antiviral drugs： Foscarnet sodium （50-60 mg/kg） was given twice a day by intravenous drip for more than two weeks followed by Ganciclovir （5 mg/kg） with the same method. High-dose Gammaglobulin （200 500 mg/kg, d） was given by intravenous drip for fourteen days. Then, low-dose broad-spectrum antibiotic was prophylactic used to prevent secondary infections. Drugs addressing gastrointestinal bacterial flora or constipating remedy, such as Bifidobiogen-Livzon, Smecta and Ioperamide were used to regulate the gastrointestinal bacterial flora and antidiarrheal. At last, adjust the amount of immunosuppressant therapy and symptomatic support. After treating, two cases were cured, 1 case gave up treatment. The results suggest that early correct diagnosis, suitable use of drugs and adjustment of immunosuppresives are keys to severe gastrointestinal CMV infection after renal transplantation.