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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 ,2 4h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 :10 0例受者术后头 3个月检出CMV PP65抗原阳性 4 2例 ,5 8例抗原阴性的受者仅 1例发生CMV病。 4 2例CMV PP65抗原阳性受者丙氧鸟苷治疗后 3 6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 2 4 6± 11 3天 ,平均疗程为 3 4 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 0 1)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
Objective: To investigate the prevention of cytomegalovirus (CMV) after renal transplantation. Methods: Immunohistochemical method was used to detect CMV PP65 antigen in peripheral blood leukocytes. The first three months after operation were examined once a week for the first time. CMV PP65 antigen was detected for the first time and gonadotropin 25 ~ 5 mg / kg · D) intravenous infusion for at least 4 weeks or until CMV PP65 antigen is negative for 7 to 14 days; if invalid, or if ganodeotide is toxic, use sodium phosphate phosphate. Results: In the first 3 months postoperatively, 42 patients were positive for CMV PP65 antigen, while only 1 patient was negative for CMV disease in 58 recipients with negative antigen. 36 (85.7%) antigens of 4 2 CMV PP65 antigen positive patients treated with ganciclovir were negative and 6 patients treated with sodium phosphate were also negative for antigens. The average time for negative conversion was 246 ± 11 3 days , The average course of treatment was 324 ± 7 1 days; only 1 case developed CMV disease. The morbidity and mortality of CMV disease (P <0.01) were significantly lower than those of control subjects who did not receive prophylactic antiviral therapy. Conclusion: The detection of CMV PP65 antigen can be used to guide the preventive treatment of CMV infection in renal transplant recipients. Prophylactic antiviral therapy can effectively reduce the incidence and mortality of CMV-positive CMV disease