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目的总结免疫健全者重症肺炎后活动性巨细胞病毒感染的临床特征和诊治要点。方法报告2例于我院呼吸重症监护病房诊治的基础免疫健全宿主重症肺炎后巨细胞病毒活动性感染病例,并结合文献资料对该病的危险因素、临床特征和诊治要点进行分析。结果 2例患者均为老年患者,因“重症肺炎、Ⅰ型呼吸衰竭”入住我科,经有创机械通气、广谱抗生素抗感染、激素抗炎及支持治疗后体温正常,氧合改善,肺部渗出影吸收好转,成功脱机拔管。之后患者氧合进一步改善不明显,且肺部渗出影进展,外周血巨细胞病毒DNA转阳,加用更昔洛韦抗病毒治疗后氧合改善,肺部渗出影吸收。结合文献资料,在基础免疫健全者,重症肺炎后出现活动性巨细胞病毒感染的危险因素包括有创机械通气、糖皮质激素应用;临床特征为氧合恶化、肺部渗出影增多,而普通细菌、真菌培养无阳性发现;诊断试验包括外周血巨细胞病毒定量核酸扩增试验、巨细胞病毒pp65抗原检测和组织病理学检查;治疗方法推荐缬更昔洛韦片口服或更昔洛韦静脉滴注,疗程至少2周。结论巨细胞病毒活动性感染在基础免疫功能正常的危重症患者中频发,对于原发疾病为重症肺炎、接受有创机械通气及应用糖皮质激素的患者,需警惕巨细胞病毒肺炎的发生,及早诊断并给予相应的治疗,可改善该类患者的预后。
Objective To summarize the clinical features and diagnosis and treatment of active cytomegalovirus infection after immune-critical severe pneumonia. Methods Two cases of active cytomegalovirus infection after severe pneumonia were diagnosed in our hospital based on the diagnosis and treatment of respiratory intensive care unit. The risk factors, clinical features and diagnosis and treatment of the disease were analyzed based on the literature. Results Both of the 2 patients were elderly patients. Because of “severe pneumonia, type Ⅰ respiratory failure,” they were admitted to our department. After mechanical ventilation, anti-infectives with broad-spectrum antibiotics, normal anti-inflammatory and supportive hormone therapy, oxygenation improved , Pulmonary leaking shadow absorption improved, successful offline extubation. After further improvement in patients with oxygen is not obvious, and pulmonary exudative progress, cytomegalovirus DNA positive peripheral blood, add ganciclovir antiviral therapy to improve oxygenation, pulmonary exudative shadow absorption. Combined with the literature, risk factors for active cytomegalovirus infection in patients with basal immunity, severe pneumonia include invasive mechanical ventilation and glucocorticoid use; clinical features include worsening oxygenation and increased pulmonary effusion, while general Bacteria, fungal culture no positive findings; diagnostic tests include cytomegalovirus quantitative nucleic acid amplification test, cytomegalovirus pp65 antigen test and histopathological examination; treatment recommended valganciclovir tablets oral or ganciclovir vein Instillation, treatment at least 2 weeks. CONCLUSIONS: Cytomegalovirus active infection frequently occurs in critically ill patients with normal immune function. Patients with severe primary pneumonia, invasive mechanical ventilation and glucocorticoid need to be alert to the occurrence of cytomegalovirus pneumonia, Early diagnosis and treatment accordingly, can improve the prognosis of such patients.