缬更昔洛韦预防肺移植术后人巨细胞病毒感染13例临床分析
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摘要
目的探讨缬更昔洛韦预防肺移植术后人巨细胞病毒(human cytomegalovirus,HCMV)感染的效果。方法回顾性分析13例肺移植患者的临床资料,根据患者术前血清学HCMV抗体IgG、IgM检测、HCMV-DNA检测及供体血清学检测结果对患者进行HCMV感染危险分层。结果 13例均为HCMV感染中危患者;肺移植术后给予缬更昔洛韦900mg/d,口服,共3个月,定期检测HCMV抗体IgG、IgM及HCMV-DNA;1例术后死亡,1例失访,11例随访3~20个月,患者血清学HCMV抗体IgM及HCMV-DNA均为阴性,均未发生HCMV感染,未发生白细胞计数及血小板计数减低等情况。结论口服缬更昔洛韦3个月预防肺移植术后HCMV感染安全、有效。
Objective To investigate the effect of valganciclovir on preventing human cytomegalovirus(HCMV)infection after lung transplantation.Methods The clinical data of 13 patients with lung transplantation were retrospectively analyzed,and the risk stratification of HCMV was evaluated according to preoperative serum cytomegalovirus IgG antibody,IgM and HCMV-DNA of the patients as well as the serological test results of donor lung.Results All 13 patients had moderate HCMV risk score.The patients were orally administrated with 900 mg/d of valganciclovir after lung transplantation for 3 months.The levels of IgG antibody,IgM antigen and HCMV-DNA were detected.Eleven patients were followed up for 3 to 20 months,one patient died after operation and one lost follow-up.IgM antibody and HCMV-DNA were negative in 11 patients,neither HCMV infection nor leucocytopenia and thrombocytopenia occurred.Conclusion Oral administration of valganciclovir for 3 months is safe and effective for preventing HCMV after lung transplantation.
Objective To investigate the effect of valganciclovir on preventing human cytomegalovirus(HCMV)infection after lung transplantation.Methods The clinical data of 13 patients with lung transplantation were retrospectively analyzed,and the risk stratification of HCMV was evaluated according to preoperative serum cytomegalovirus IgG antibody,IgM and HCMV-DNA of the patients as well as the serological test results of donor lung.Results All 13 patients had moderate HCMV risk score.The patients were orally administrated with 900 mg/d of valganciclovir after lung transplantation for 3 months.The levels of IgG antibody,IgM antigen and HCMV-DNA were detected.Eleven patients were followed up for 3 to 20 months,one patient died after operation and one lost follow-up.IgM antibody and HCMV-DNA were negative in 11 patients,neither HCMV infection nor leucocytopenia and thrombocytopenia occurred.Conclusion Oral administration of valganciclovir for 3 months is safe and effective for preventing HCMV after lung transplantation.
引文
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[2]中华医学会器官移植学分会.中国实体器官移植受者巨细胞病毒感染诊疗指南(2016版)[J].中华器官移植杂志,2016,37(9):561-565.
[3]李欢,张三陵,邓建川,等.异基因造血干细胞移植术后患者血CMV-DNA的定期监测及危险因素分析[J].重庆医学,2015,44(29):4036-4038,4041.
[4]韩永,蔡明,郭晖,等.移植肾术后急性抗体介导性排斥反应的诊断与治疗[J].中华实用诊断与治疗杂志,2015,29(1):34-36.
[5]韩永,黄海燕,许晓光,等.肾移植术后巨细胞病毒感染诊断、预防与治疗[J].中华实用诊断与治疗杂志,2011,25(1):52-54.
[6]赵士魁,马康,郭庆明,等.盐酸缬更昔洛韦的合成[J].中国医药工业杂志,2015,46(2):120-122.
[7]周琳,钱景,蔡挺,等.心肺移植患者巨细胞病毒耐更昔洛韦基因突变研究[J].中华传染病杂志,2002,20(1):37-40.
[8]Kotton CN,Kumar D,Caliendo AM,et al.Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation[J].Transplantation,2013,96(4):333-360.
[9]Finlen Copeland CA,Davis WA,Snyder LD,et al.Long-term efficacy and safety of 12 months of valganciclovir prophylaxis compared with 3 months after lung transplantation:a singlecenter,long-term follow-up analysis from a randomized,controlled cytomegalovirus prevention trial[J].J Heart Lung Transplant,2011,30(9):990-996.