肝移植术后巨细胞病毒相关胆道病的研究

Research of cytomegalovirus-related biliary diseases after liver transplantation

目的探讨肝移植术后胆道并发症患者中胆汁巨细胞病毒(CMV)DNA的检测价值及意义。方法回顾性分析2012年12月至2017年1月首都医科大学附属北京友谊医院收治的24例肝移植术后发生胆道并发症的患者,比较其同一时期胆汁与血液CMV DNA的检测结果,观察CMV感染对肝移植术后发生胆道并发症患者预后的影响。结果24例患者中,胆汁CMV DNA阳性13例,阳性率为54.2%;血液CMV DNA阳性2例患者,阳性率为8.3%(P=0.001);其中,胆汁CMV DNA和血液CMV DNA均阳性2例。对这24例患者定期随访至2017年12月,有4例患者发生移植物失功,且其胆汁CMV DNA检测结果均为阳性,在这4例患者中,3例患者接受再次移植,1例患者因移植物失功而死亡。另外,在20例未发生移植物失功的患者中,有1例患者于移植术后1个月因脓毒血症而死亡。结论检测胆汁CMV DNA对肝移植术后发生CMV相关胆道病患者的诊断及对发生胆道并发症患者的治疗具有重要意义,且胆汁CMV DNA检出阳性率比血液高。

Objective To investigate the value and significance of bile cytomegalovirus（ CMV） DNA in patients with biliary complications after liver transplantation. Methods This research conducted a retrospective analysis of 24 patients with biliary complications who underwent liver transplantation in Beijing Friendship Hospital,Capital Medical University from December 2012 to January 2017 and compared the levels of CMV DNA in the bile and blood,which were sampled concurrently. To investigate the effect of CMV infection on the prognosis of patients with biliary complications after liver transplantation. Results CMV DNA was detected in the bile samples of 13 of 24 patients in the study and the positive identification rate for CMV DNA in the bile was 54. 2%. CMV DNA was detected in the blood samples of 2 of 24 patients and the positive identification rate for CMV DNA in the blood was 8. 3%（ P = 0. 001）. Furthermore,CMV DNA was concurrently detected in the blood and bile sample of 2 patients. Followed up to December 2017,4 patients experienced graft failure with positive biliary CMV DNA. Among these 4 patients,3 patients underwent retransplantation,and 1 patient eventually died due to graft failure. In addition,1 patient of the 20 patients who were without graft failure died due to sepsis one month after liver transplantation. Conclusion Detecting bile CMV DNA is important for the diagnosis of patients with cytomegalovirus-related biliary diseases and the treatment of patients with biliary complications after liver transplantation,and the positive identification rate for CMV DNA in the bile is higher than that of blood.