肾移植术后巨细胞病毒肺炎的诊治

Diagnosis and treatment of cytomegalovirus pneumonitis following renal transplantation

目的 探讨肾移植术后巨细胞病毒 (CMV)肺炎的诊断和治疗。方法 回顾性总结 32例肾移植术后发生CMV肺炎的临床资料 ;通过检测外周血中CMVIgM和 (或 )CMVDNA ,结合临床症状及胸片明确诊断 ;以更昔洛韦治疗 ,同时防治混合感染 ,加强营养支持 ,并根据动脉血氧分压 ,尽早使用呼吸机。结果 2 7例 ( 84 .4 % )治疗有效 ,其中 2 5例治愈 ,2例好转 ;死亡 5例。结论 对肾移植术后CMV肺炎应尽早诊断、及时应用以更昔洛韦为主的综合治疗。

Objectives To introduce the experience in diagnosis and treatment of cytomegalovirus (CMV) pneumonitis following cadaver renal transplantation. Methods Thirty two renal transplant recipients were diagnosed as having CMV pneumonitis by the detection of CMV IgM and CMV DNA in combination with the clinical symptoms and chest X ray. CMV IgM and CMV DNA were detected in peripheral blood specimens by ELISA and fluorescent quantitative PCR assays respectively. The treatments included administration of Ganciclovir, prevention and treatment of superinfection, improvement of nutrition and use of respirator as early as possible. Results It was effective in 27 with 25 being cured and 2 being improved. Five of 32 finally died. The total effective rate was 84.4% (27/32). Conclusions Early diagnosis and prompt treatment are effective for CMV pneumonitis following renal transplantation.