新常态下器官移植受者新型冠状病毒感染诊疗策略

Treatment strategies for COVID-19 in organ transplant recipients under the new normal

新型冠状病毒(以下简称新冠病毒)自发现以来,已历经多次变异。随着新冠病毒奥密克戎变异株的出现及其持续时间的延长,机体的免疫保护作用也随之下降。虽然普通人群二次感染的发生率相对较低,但实体器官移植受者(solid organ transplant recipient,SOTR)作为免疫抑制宿主,其新冠病毒二次感染甚至三次感染的发生率和重症率仍高于普通人群。而且SOTR也面临其它呼吸道病毒(如流行性感冒病毒、呼吸道合胞病毒等)和多种机会性病毒感染的高风险,需仔细甄别并给予精准化诊疗。多款小分子抗病毒药物的上市给新冠病毒的治疗方案带来更多新选择。本文从SOTR角度,简要述评新形势下新冠病毒变异株的特点、SOTR感染新冠病毒新变异株情况和防治策略、新型抗病毒药物的特点,探讨了SOTR新冠病毒再感染的特点、鉴别诊断和诊疗方案的优化选择。

Currently COVID-19 variant virology and its prevalence both domestically and internationally have become a new norm.With the emergence of Omicron variant,the protective effect of original preventive measures against reinfection with variant strains has declined.Current prevalence of COVID-19 variant strains,the mechanisms of reinfection and the risks of reinfection in solid organ transplant recipients(SOTR)were discussed.Immunocompromised individuals,especially SOTR,face an elevated risk of multiple infections,such as seasonal influenza and respiratory syncytial virus,during high transmission seasons for respiratory viruses and require special care and protection.With the introduction of several small molecule drugs,there are now more options available for antiviral regimens.This review offered a brief overview of the characteristics of COVID-19 variant strains in the current scenario,disease incidence among SOTR in China,unique features of novel antiviral agents and optimizing the selection of diagnostic and therapeutic plans.