肾移植术后巨细胞病毒性肺炎的诊断与治疗

The diagnosis and treatment of cytomegalovirus pneumonia in renal allograft recipient

目的 探讨肾移植术后并发巨细胞病毒 (CMV)肺炎的诊断与治疗。方法 对 5 6例肾移植患者中 ,术后并发巨细胞病毒性肺炎的临床资料进行回顾性分析。结果 5 6例中并发巨细胞病毒性肺炎 7例 ( 12 5 % ) ,平均发生时间在术后 99 1天。均以发热、咳嗽起病 ,胸部X线检查均为间质性肺炎改变。 7例中CMV IgM阳性者 3例 ,CMVDNA阳性 7例 ,pp6 5抗原阳性 5例。病情进展迅速 ,3例合并急性呼吸窘迫综合征。 3例痊愈 ,3例死亡 ,1例放弃治疗。结论 肾移植术后并发CMV肺炎病情凶险 ,应加强CMV监测。联合应用CMVpp6 5抗原血症检测及CMVDNA检测有利于早期诊断和治疗。早期使用以更昔洛韦抗病毒为主的综合治疗 ,调整免疫抑制剂用量、吸氧、无创辅助呼吸。

Objective To study the diagnosis and treatment of the cytomegalovirus(CMV)pneumonia in patients with post renal transplantation.Methods A retrospective analysis was made on 7 severe CMV pneumonia cases among 56 renal allograft recipients.The onset of CMV pneumonia starts in 2～4 months (mean 99 1 days) after renal transplantation.It begins with high fever and cough.The X ray examination of chest always showed interstitial changes. Among the 7 cases only 3 were positive to CMV IgM,while 7 and 5 cases were positive to CMV DNA and CMV pp65Ag.The disease developed quickly,and 3 of them were complicated with ARDS.After treatment,3 of the 7 patients recovered,while other 3 died,and the rest one gave up the management. Conclusion Post renal transplantation CMV pneumonia is a severe complication.It′s important to detect both CMV DNA and CMV pp65Ag to make early diagnosis and treatment.We specially stress the importance of providing combined therapy which includes ganciclovia therapy,the adjustment of the dosage of the immunosuppressants,correcting hypoxia and the supportive therapy.