摘要
目的探讨肾移植术后重症巨细胞病毒（CMV）性肺炎时停用基础免疫抑制剂联合使用丙种球蛋白的安全性和有效性。方法肾移植术后发生重症CMV肺炎患者19例。男13例，女6例。年龄26～55岁，平均35岁。均以发热起病，继而出现进行性加重的呼吸困难。胸部X线片呈间质性或浸润性病变。19例CMV-PP65抗原或CMV-IgG和IgM抗体阳性。感染均发生于术后2～4个月，17例发生急性呼吸衰竭，其中10例为急性呼吸窘迫综合征。19例在感染早期均采用抗细菌、抗病毒（更昔洛韦0．25g，2次／d）、抗真菌（氟康唑0．2～0．4g／d）的综合治疗措施。19例在感染加重或呼吸衰竭后均停用以环孢素为基础的三联免疫抑制剂，停药3d以上者使用甲泼尼龙40～80mg／d，同时使用大剂量丙种球蛋白（15～25g／d），疗程7～25d，平均15d。结果停环孢素最长者42d，最短者1d，平均16d，仅1例在减少和停用环孢素后第3天出现急性排斥反应，余18例停药期间血肌酐（86～124μmol／L）稳定。2例并发多脏器功能衰竭死亡，17例抢救成功。结论肾移植术后发生的CMV肺炎，早期停用基础免疫抑制剂联合丙种球蛋白治疗安全有效。
Objective To study the therapeutic effect of discontinuance of immunosuppressive agents combined with intravenous immunoglobin in severe cytomegalovirus（CMV） pneumonia in kidney transplantation patients. Methods The clinical data of 19 patients （13 men and 6 women）with severe CMV pneumonia following kidney transplantation were retrospectively analyzed. The mean age was 35 years（range,26-55 years）. All 19 patients suffered from CMV pneumonia in 2-4 months after renal transplantation. Of them 17 cases had acute respiratory failure of type Ⅰ, including 10 cases having ARDS. All cases suffered from fever and dyspnea, and their X-ray showed interstitial edema and shadow changes. CMV-PP65 antigen or CMV-IgM antibody was positive in all cases. In early phases of all cases, empirical therapy was initiated with ganciclovir （0.25 g, q12h） Combined with antibiotics and anti-fungi agents（fluconazol 0.2-0.4 g/d）. All cases stopped using immunosuppressive agents based on CsA after pneumonia got deteriorated or acute respiratory failure was diagnosed. Methylprednisolone was routinely injected after 3 d of discontinuance of immunosuppressive agents. The dose of methylprednisolone was 40-80 mg/d. High dose of intravenous immunoglobin （15-25 g/d）was used in all cases, and the course of treatment was 7-25 d, mean 15 d. Results The period of discontinuance of immunosuppressive agents was 1-42 d, average 16 d. Eighteen cases had normal kidney function （serum creatinine 86-124μmol/L）, except 1 case underwent mild acute rejection. Seventeen cases were cured and 2 died of multiple organ failure. Conclusions Discontinuance of immunosuppressive agents combined with intravenous immunoglobin in severe cytomegalovirus pneumonia in kidney transplantation patients was safe and effective.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2007年第3期179-182,共4页
Chinese Journal of Urology
关键词
肾移植
巨细胞病毒
肺炎
病毒性
Kidney transplantation
Cytomegalovirus
Pneumonia
作者简介
通信作者：石炳毅，Email：shibingyi@medmail.com.cn
