肾移植后巨细胞病毒感染的诊断与治疗

THE DIAGNOSIS AND TREATMENT OF CYTOMEGALOVIRUS INFECTION AFTER RENAL TRANSPLANTATION

研究肾移植术后巨细胞病毒 (CMV)感染的诊断及预防性使用膦甲酸钠 (PFA)治疗的疗效与毒副作用。采用ELISACMV特异性抗体IgG、IgM方法 ,针对肾移植术后 74例CMV活动期感染(34例有明显临床症状 )和 2 5例静止期患者使用PFA ,另选 10例静止期病例不予处理作为对照。结果显示 ,无症状的活动期病例PFA平均使用 12 .5天后血清学结果转阴 ;有临床症状的 34例中 ,应用 15天后 32例显效 ,另 2例治疗 1个月后血清学结果转阴 ,随访 1年无复发 ;静止期治疗组用药后观察 1年 ,发现 2例血清IgM转阳 ,但无临床症状 ;对照组 10例中有 3例分别于随访 1、2、3个月时发生CMV活动性感染。研究表明 ,PFA可快速治疗CMV感染 ,疗效确切而显著 ,随访期内复发少见 ;静止期患者使用PFA与否 ,随访期内血清学的检查结果差异显著 ;PFA对移植肾功能无明显损害 ,不干扰血钙及环孢素A的代谢 。

To study the diagnosis of cytomegalovirus (CMV) infection after renal transplantation and the effects and side effects of preventive use of foscarnet (PFA). ELISA assay was used to determine active CMV infection (IgM+,IgG+) and inactive CMV infection (IgM-,IgG+). Seventy four cases of active CMV infection and 25 of inactive CMV infection were selected to receive PFA treatment. Besides, 10 cases of inactive CMV infection without PFA treatment served as a control group. The results showed that the serological tests turned negative in subclinical patients in active stage after 12 5 days of treatment. In those patients with clinical symptoms, infection was controlled in 34 patients after 15 days of treatment. In another 2 patients, serology turned negative after 1 month of treatment, and no recurrence found one year later. In patients in inactive stage, IgM became positive, but with no symptoms, one year after treatment. At the same time, 3 patients in the control group turned into active infection after 1, 2 and 3 months. The results suggested ELISA assay was a good method to determine serum CMV IgG and IgM at present; PFA could definitively control active CMV infection quickly, and no recurrence was found during 1 year follow up; PFA might prevent reversion of serological indexes in patients with inactive infection. Moreover, PFA did not impose damage to the function of the renal graft, and nor interfered with the metabolism of blood calcium and cyclosporine A. Thus, PFA is a safe and effective drug to treat CMV infection.