肾移植受者巨细胞病毒感染及免疫抑制剂的影响

Incidence of Cytomegalovirus Infection and the Effects of Immunosuppressants on It in Renal Allograft Recipients

目的 探讨肾移植受者巨细胞病毒 (CMV)感染率及免疫抑制剂对其的影响。方法 2 14例肾移植受者术后静滴甲泼尼龙 (Mp)、抗淋巴细胞球蛋白 (AL G)作为诱导期免疫抑制治疗 ;基础免疫抑制剂治疗为环孢素 A、泼尼松和硫唑嘌呤 ;急性排斥反应时静滴 Mp治疗 ,无效时给予 AL G或 OKT;采用免疫细胞化学法测定外周血白细胞 CMV- PP6 5抗原 ,术后头 3个月每周 1次。结果 2 14例肾移植受者中 ,12 6例 (6 1.7%)术后发生 CMV感染 ;70例 (32 .7%)发生急性排斥反应 ,其中 5 2例 (74 .3%)发生 CMV感染 ,明显高于无急性排斥反应患者的5 1.4 %(P<0 .0 1) ;在 12 6例 CMV感染和 88例无 CMV感染的肾移植受者中 ,诱导期免疫抑制剂 AL G平均剂量分别为 (14 .1± 1.3)支和 (13.2± 0 .9)支 (P>0 .0 5 ) ,平均疗程分别为 (4.7± 1.3) d和 (4.4± 0 .9) d(P>0 .0 5 ) ,急性排斥反应发生率分别为 4 2 .3%和 2 0 .5 %(P<0 .0 1)。结论 肾移植受者术后 CMV感染率高 ;术后短期的AL G诱导治疗可能不增加 CMV感染发生率 ;急性排斥反应后免疫抑制剂尤其是 AL G或 OKT3的使用与 CMV感染密切相关。

OBJECTIVE To investigate the incidence of cytomegalovirus (CMV) infection and the effects of immunosupressants on CMV infection in the renal allograft recipients. METHODS Two hundred and fourteen recipients were treated with methylprednisolone (Mp) and antilymphocyte globulin (ALG) as induced immunosuppressive therapy after renal transplantation. The basic immunosuppressants included ciclosporine A, prednisone and azathioprine. Recipients with acute reject reaction first received the Mp treatment. If the Mp treatment was no effect, ALG or muromonab3 CD 3(OKT 3) should be prescribed. CMV PP65 antigen was checked by immunocytochemical methods at weekly intervals during the first 3 months after transplantation. RESULTS One hundred and twenty six of 214 recipients (61.7%) developed CMV infection. average of the dosages of ALG in the induced immunosuppressive treatment was not significantly different (14.1±1.32 vs 13.2±0.92, P>0.05), 52 (42.3%) and 18 (20.5%) recipients of them had acute reject reaction respectively (P<0.01). Seventy cases (32.7%) had acute reject reaction, 52 of them (74.3%) developed CMV infection, and significantly higher than that of the recipients with no CMV infection (P<0.01). CONCLUSIONS We suggest that the incidence of CMV infection in renal allograft recipients be high. Induced immunosuppressive therapy with low dosages of ALG may not increase the incidence of CMV infection. The ALG or OKT3 treatment after acute reject reaction may be relative with CMV infection in renal allograft recipients.