学术背景:巨细胞病毒感染是异基因造血干细胞移植后的常见并发症,病死率极高。目的:综述移植后巨细胞病毒感染的诊断和防治等研究进展。检索策略:应用计算机检索PubMed1999-01/2006-12期间的相关文章,检索词为"infection post tran...学术背景:巨细胞病毒感染是异基因造血干细胞移植后的常见并发症,病死率极高。目的:综述移植后巨细胞病毒感染的诊断和防治等研究进展。检索策略:应用计算机检索PubMed1999-01/2006-12期间的相关文章,检索词为"infection post transplant,CMV,interstitial pneumonia,valacyclovir,ganciclovir"。同时机检索万方数据库2001-01/2006-12期间的相关文章,检索词为"移植后感染,巨细胞病毒,间质性肺炎,万乃洛韦,更昔洛韦"。对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与移植后巨细胞病毒感染的诊断和防治等研究进展中的应用相关。排除标准:重复研究或Meta分析类文章。共收集到66篇相关文献,35篇文献符合纳入标准,排除的31篇为内容陈旧或重复文献。文献评价:符合纳入标准的35篇文献中,15篇涉及移植后巨细胞病毒感染的临床表现与诊断,16篇涉及移植后巨细胞病毒感染的防治,4篇涉及存在的问题与展望。资料综合:巨细胞病毒性间质性肺炎是移植后巨细胞病毒疾病的主要类型。没有特异性的临床和X射线表现可以将巨细胞病毒肺炎和其他条件病原体肺炎区别开来,只有从下呼吸道支气管灌注液、支气管镜活检或肺组织活检标本中检出巨细胞病毒,结合相应的临床表现才可以诊断巨细胞病毒肺炎。抗病毒药物可能会减少原发性巨细胞病毒感染的发生。阿昔洛韦可以明显减少巨细胞病毒感染的发生率,延缓术后巨细胞病毒感染的起病时间,大剂量万乃洛韦可将巨细胞病毒感染的风险降低。结论:联合使用抗病毒药物可以降低巨细胞病毒感染的发生率,提高移植后患者的生存率。展开更多
Pure red cell aplasia （PRCA） due to parvovirus B19 （PVB19） infectiori after solid organ transplantation has been rarely reported and most of the cases were renal transplant recipients, Few have been described afte...Pure red cell aplasia （PRCA） due to parvovirus B19 （PVB19） infectiori after solid organ transplantation has been rarely reported and most of the cases were renal transplant recipients, Few have been described after liver transplantation. Moreover, little information on the management of this easily recurring disease is available at present. We describe the first case of a Chinese liver transplant recipient with PVB19-induced PRCA during immunosuppressive therapy. The patient suffered from progressive anemia with the lowest hemoglobin level of 21 g/L. Bone marrow biopsy showed selectively inhibited erythropoiesis with giant pronormoblasts. Detection of PVB19-DNA in serum with quantitative polymerase chain reaction （PCR） revealed a high level of viral load. After 2 courses of intravenous immunoglobulin （IVIG） therapy, bone marrow erythropoiesis recovered with his hemoglobin level increased to 123 g/L. He had a lowlevel PVB19 load for a 5-too follow-up period without recurrence of PRCA, and finally the virus was cleared. Our case indicates that clearance of PVB19 by IVIG in transplant recipients might be delayed after recovery of anemia.展开更多
文摘学术背景:巨细胞病毒感染是异基因造血干细胞移植后的常见并发症,病死率极高。目的:综述移植后巨细胞病毒感染的诊断和防治等研究进展。检索策略:应用计算机检索PubMed1999-01/2006-12期间的相关文章,检索词为"infection post transplant,CMV,interstitial pneumonia,valacyclovir,ganciclovir"。同时机检索万方数据库2001-01/2006-12期间的相关文章,检索词为"移植后感染,巨细胞病毒,间质性肺炎,万乃洛韦,更昔洛韦"。对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与移植后巨细胞病毒感染的诊断和防治等研究进展中的应用相关。排除标准:重复研究或Meta分析类文章。共收集到66篇相关文献,35篇文献符合纳入标准,排除的31篇为内容陈旧或重复文献。文献评价:符合纳入标准的35篇文献中,15篇涉及移植后巨细胞病毒感染的临床表现与诊断,16篇涉及移植后巨细胞病毒感染的防治,4篇涉及存在的问题与展望。资料综合:巨细胞病毒性间质性肺炎是移植后巨细胞病毒疾病的主要类型。没有特异性的临床和X射线表现可以将巨细胞病毒肺炎和其他条件病原体肺炎区别开来,只有从下呼吸道支气管灌注液、支气管镜活检或肺组织活检标本中检出巨细胞病毒,结合相应的临床表现才可以诊断巨细胞病毒肺炎。抗病毒药物可能会减少原发性巨细胞病毒感染的发生。阿昔洛韦可以明显减少巨细胞病毒感染的发生率,延缓术后巨细胞病毒感染的起病时间,大剂量万乃洛韦可将巨细胞病毒感染的风险降低。结论:联合使用抗病毒药物可以降低巨细胞病毒感染的发生率,提高移植后患者的生存率。
文摘Pure red cell aplasia （PRCA） due to parvovirus B19 （PVB19） infectiori after solid organ transplantation has been rarely reported and most of the cases were renal transplant recipients, Few have been described after liver transplantation. Moreover, little information on the management of this easily recurring disease is available at present. We describe the first case of a Chinese liver transplant recipient with PVB19-induced PRCA during immunosuppressive therapy. The patient suffered from progressive anemia with the lowest hemoglobin level of 21 g/L. Bone marrow biopsy showed selectively inhibited erythropoiesis with giant pronormoblasts. Detection of PVB19-DNA in serum with quantitative polymerase chain reaction （PCR） revealed a high level of viral load. After 2 courses of intravenous immunoglobulin （IVIG） therapy, bone marrow erythropoiesis recovered with his hemoglobin level increased to 123 g/L. He had a lowlevel PVB19 load for a 5-too follow-up period without recurrence of PRCA, and finally the virus was cleared. Our case indicates that clearance of PVB19 by IVIG in transplant recipients might be delayed after recovery of anemia.
