课题背景：新型强效免疫抑制剂的广泛应用使肾移植术后急性排斥反应发生率明显降低，但过度免疫抑制会导致感染增加，严重影响肾移植患者预后。其中，肾移植术后巨细胞病毒肺炎病情进展迅速，治疗效果欠佳，已逐渐成为肾移植术后患者死亡和移植肾失功的重要原因之一。总结肾移植术后巨细胞病毒肺炎的发病特征并探寻治疗方案对于提高肾移植患者预后具有重要意义。

应用要点：①肾移植术后巨细胞病毒肺炎主要发生在移植术后早期，以术后前3个月多见。②术后早期定期检查巨细胞病毒-IgM和巨细胞病毒-DNA有助于及早发现巨细胞病毒肺炎。③较低的免疫抑制剂浓度可能有助于降低巨细胞病毒肺炎的发生率。④抗病毒治疗同时尽早减少或停用免疫抑制剂是治疗肾移植后巨细胞病毒肺炎的关键。

偏倚或不足：对肾移植术后巨细胞病毒肺炎患者治愈以后的观察时间不够长，需继续观察人/肾长期存活情况；病例总数不多，拟在今后研究中进一步补充。

摘要

目的：肾移植术后巨细胞病毒肺炎病情进展迅速，治疗效果欠佳，已逐渐成为肾移植术后患者死亡和移植肾失功的重要原因之一。总结肾移植术后巨细胞病毒肺炎的发病特征，探寻其治疗方案。
方法：①2003-01/2007-09首都医科大学附属北京同仁医院移植中心收治的同种异体肾移植患者156例，其中12例肾移植术后发生巨细胞病毒肺炎。②细胞病毒肺炎患者的治疗方案主要包括抗病毒、尽早减少或完全停用免疫抑制剂、辅助呼吸等。③回顾分析其临床资料，包括巨细胞病毒肺炎的发病率、发病年龄、发病时间、临床表现、治疗经过及死亡率，总结其治疗经验。
结果：①156例肾移植患者中12例术后出现巨细胞病毒肺炎，发病率为7.7%。②患者年龄21~67岁，平均37岁。③发病时间为术后53~900 d，其中术后3个月内8例，4~6个月3例，6个月以后1例。④主要临床表现为发热、憋气以及进行性呼吸困难。⑤患者诊断为巨细胞病毒肺炎后立即予更昔洛韦抗病毒治疗，尽早减少免疫抑制剂用量，将环孢素A和他克莫司血药浓度分别维持在75 μg/L和2 μg/L左右，病情加重甚至出现急性呼吸窘迫综合征时停用所有免疫抑制剂。⑥12例患者痊愈10例（占83.3%），死亡2例（占16.7%）。
结论：抗病毒治疗同时尽早减少或停用免疫抑制剂是治疗肾移植后巨细胞病毒肺炎的关键。
关键词：肾移植；巨细胞病毒感染；器官移植

张昆鹏，顾梅，龙志华，关炳星，党受涛.肾移植术后巨细胞病毒肺炎发病特征及治疗：12例分析[J].中国组织工程研究与临床康复，2008，12(18):3423-3426 [www.zglckf.com/zglckf/ejournal/upfiles/08-18/18k-3423(ps).pdf]

Characteristics and treatment of cytomegalovirus pneumonia in 12 renal transplantation patients

Abstract

AIM: Cytomegalovirus pneumonia (CMV-P) develops fast after renal transplantation, but the therapeutic effect is not satisfactory, CMV-P has become one of important reasons for the death of patients and the dysfunction of transplanted kidney following renal transplantation. This study was designed to investigate clinical characteristics and treatment of CMV-P after renal transplantation.
METHODS: A total of 156 patients received allograft renal transplantation in the transplantation center in Beijing Tongren Hospital Affiliated of Capital Medical University from January 2003 to September 2007, and 12 of them occurring CMV-P were adopted in this study. The main treatment of CMV-P included antiviral therapy, reducing or withdraw the dosage of immunosuppressant as soon as possible and assisted respiration, etc. Clinical data of CMV-P patients after renal transplantation were analyzed on their morbidity rate, age, morbidity time, clinical manifestations, treatment and mortality rate. Then the treatment experience was concluded.
RESULTS: There were 12 of 156 renal transplantation recipients having CMV-P, and the morbidity rate was 7.7%. The average age of patients was 37 years, ranging 21-67 years. The interval from operation to onset was 53-900 days, and 8 of them within 3 months, 3 during 4-6 months, and 1 after 6 months. Fever, breath holding and progressive dyspnea were the primary clinical manifestation. The treatments included Ganciclovir antiviral therapy and reducing the dosage of immunosuppressant as soon as possible. The concentrations of ciclosporin A and tacrolimus were maintained around 75 μg/L and 2 μg/L, respectively. All immunosuppressive drugs would be withdrawn if patient's condition turned for the worse or acute respiratory distress syndrome occurred. Among 12 patients, 10 (83.3%) patients were cured and 2 (16.7%) patients died.
CONCLUSION: The most important treatment of CMV-P after renal transplantation is reducing or withdrawing immunosuppressive drugs at the same time of antiviral therapy.

Zhang KP, Gu M, Long ZH, Guan BX, Dang ST. Characteristics and treatment of cytomegalovirus pneumonia in 12 renal transplantation patients.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(18):3423-3426
[www.zglckf.com/zglckf/ejournal/upfiles/08-18/18k-3423(ps).pdf]