２１例肾脏疾病患者免疫抑制剂治疗后继发巨细胞病毒肺炎救治.docVIP

２１例肾脏疾病患者免疫抑制剂治疗后继发巨细胞病毒肺炎救治 　　【摘要】目的 观察肾脏疾病免疫抑制剂治疗后继发巨细胞病毒(CMV)肺炎的临床特征、治疗和转归。方法 在1999年6月至2006年12月在中山大学附属第一医院接受免疫抑制剂治疗的肾脏疾病患者中，采用免疫细胞化学法对外周血和(或)支气管肺泡灌洗液白细胞进行CMV抗原检测，同时结合临床表现，将21例诊断为CMV肺炎，并给予丙氧鸟苷5～10 mg?kg-1?d-1静脉滴注，停用免疫抑制剂治疗。现回顾性分析其临床特征和预后。结果 21例患者发生CMV肺炎前均使用了皮质激素，13例为甲基泼尼松冲击治疗，平均总剂量为(3．2±0．6) g，15例接受环磷酰胺治疗，平均总剂量为(3．8±1．3） g，免疫抑制剂使用到诊断CMV肺炎的时间中位数为25(13～92) d；21例患者均有发热、干咳、气促气喘，X线胸片均示间质性肺炎，19例伴低氧血症，11例支气管灌洗液白细胞CMV抗原阳性。9例患者存活，12例(57．2%)死亡。然而丙氧鸟苷平均疗程为(26．2±6．3) d。结论 CMV肺炎是接受免疫抑制剂治疗的肾脏疾病患者的严重并发症，病死率高，然而丙氧鸟苷是其有效治疗药物。 　　【关键词】肾脏疾病；巨细胞病毒；肺炎；免疫抑制剂；治疗 　　 　　Effects of immunosuppressor against kidney disease in treatment of 21 patients with cytomegalovirus pneumoniaLIANG Yan-bing, MA Zhong-fu, HUANG Feng-xian, WU Pei-gen, LI You-ji, XU Yuan-wen. Medical Department , The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China 　　Corresponding author: XU Yuan-wen, Email: xuyw8591@126．com 　　 　　【Abstract】Objective To studythe clinical feature, treatment, and prognosis of the cytomegalovirus (CMV) pneumonia patients treated with immunosuppressor against kidney disease. Method The patients received immunosuppressor against kidney disease in The First Affiliated Hospital of Sun Yat-sen University from June 1999 to December 2006. CMV antigen of leucocyte in the peripheral blood and/or bronchoalveolar lavage fluid of these patients were detected with immunocytochemical methods, and 21 patients were found suffering from CMV pneumonia. The 21 patients were introvenously injected with ganciclovir 5～10 mg/(kg?d), and the immunosuppressive agent treatment suspended. Their clinical feature and prognosis were retrospectively analyzed. Results The 21 patients received corticosteroids before CMV pneumonia contracted. of them, 13 patients had been intensively treated with Methyllprednisolone with mean total dose (3．2±0．6) g. Of them, 15 had been treated with cyclophosphamide with mean total dose (3．8±1．3) g. The median time from the beginning of using immunosuppressor t