肾移植术后巨细胞病毒病的预防——CMV抗原检测指导的预防性抗病毒治疗.docVIP

???? 肾移植术后巨细胞病毒病的预防?——CMV抗原检测指导的预防性抗病毒治疗 ???? ???? 摘　要　目的：探讨肾移植术后巨细胞病毒(CMV)病的预防。　方法：采用免疫组化法检测外周血白细胞CMV-PP65抗原，术后头3个月每周检查1次，初次检测CMV-PP65抗原阳性者，24h内给予丙氧鸟苷2.5～5mg／（kg.d）静滴，疗程至少4周或至CMV-PP65抗原阴转后续用7～14天；无效或出现丙氧鸟苷毒副作用时改用磷甲酸钠。　结果：100例受者术后头3个月检出CMV-PP65抗原阳性42例，58例抗原阴性的受者仅1例发生CMV病。42例CMV-PP65抗原阳性受者丙氧鸟苷治疗后36例(85.7%)抗原阴转，6例经磷甲酸钠治疗抗原也阴转，平均阴转时间为24.6±11.3天，平均疗程为34.2±7.1天；仅1例发展为CMV病。与没有给予预防性抗病毒治疗的对照组受者相比，CMV病的发病率和死亡率（P＜0.01）明显降低。　结论：CMV-PP65抗原检测可用于指导肾移植受者CMV感染的预防性治疗；预防性抗病毒治疗可有效降低CMV抗原阳性者CMV病的发病率和死亡率。关键词　肾移植　巨细胞病毒　丙氧鸟苷 CMV-PP65 ANTIGENEMIA-GUIDED PREEMPTIVE P ROPHYLACTIC ANTIVIRAL THERAPY FOR CYTOME GALOVIRUS INFECTION IN RECIPIENTS OF CAD AVERIC RENAL ALLOGRAFTS Xu Yuanwen　Zhu Lanying　MaoHaiping　Yu Xueqing　Liang Yanbing　Wu Beigen　Chen Qing rui　Ji YulianKidney Research Institute； Zheng Keli　Hong LiangqingDepartment of Urology，The First Affiliated Hospital， Sun Yi-Xian University of Medical Scien ce， Guangzhou 510080 OBJECTIVE To evaluate the ef fectiveness of cytomegalovirus（CMV） anti genemia-guided ganciclovir（GCV） treatmen t in the prevention of CMV disease in ca daveric renal allograft recipients．METHODOLOGY CMV-PP65 antigen? in peripheral blood leukocyte was exami ned with immunohistochemical assay at we ekly intervals during the first 3 months ? after transplantation． Within the 24 ho urs? after CMV antigenemia test became positive， GCV was administered at a dose o f 2.5-5mg／kg／d intravenously for at least 4 weeks or until CMV antigenemia becam e negative．Same GCV treatment was resum ed if antigenemia recurredRESULTS In this group of 100? renal allograft recipients，42（42％） dev eloped CMV antigenemia with the applicat ion of the detection of CMV-PP65， and only 1 in 58 cases （1.7％） with negative CM V-pp65 detection developed CMV disease．CMV antigenemia in 36（85.7％） of the 42 p ositive CMV-PP65 recipients disappeared? after GCV treatment，and only 1 of them? developed CMV disease．CMV antigenemia be came negative after an average period of? 24.6±11.3 days， and the average dur