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目的 研究肾移植受者术前巨细胞病毒(CMV)感染对术后急性排斥的影响及预 防性抗病毒治疗的意义。方法 回顾性分析416例肾移植受者的术前巨细胞病毒感染,预防性 抗病毒治疗和急性排斥的发生情况,并用Logistic回归分析各因素对急性排斥的影响。术前感 染受者根据有无预防性抗病毒治疗分为治疗组和非治疗组,比较两组间急性排斥发生率。结 果 术前巨细胞病毒感染组的急性排斥率显著高于非感染组(29.9%比19.5％,P=0.014),术前 感染受者发生急性排斥的风险增高将近1倍。预防性抗病毒治疗能降低术后CMV疾病的发生 率但对急性排斥无影响。结论 术前巨细胞病毒感染是术后急性排斥独立的危险因子。常规的 预防性抗病毒治疗并不能减少由感染介导的免疫损伤而导致的急性排斥的发生。
Objective To study the effect of preoperative cytomegalovirus (CMV) infection on postoperative acute rejection in renal transplant recipients and the significance of preventive antiviral therapy. Methods The preoperative cytomegalovirus infection, preventive antiviral therapy and acute rejection in 416 renal transplant recipients were retrospectively analyzed. Logistic regression was used to analyze the influence of various factors on acute rejection. Patients with preoperative infection were divided into treatment and non-treatment groups according to the presence or absence of preventive antiviral treatment. The incidence of acute rejection was compared between the two groups. Results The acute rejection rate of preoperative cytomegalovirus infection group was significantly higher than that of non-infected group (29.9% vs 19.5%, P = 0.014). The risk of acute rejection in preoperative infection recipients was almost doubled. Prophylactic antiviral therapy can reduce the incidence of postoperative CMV disease but has no effect on acute rejection. Conclusions Preoperative cytomegalovirus infection is an independent risk factor for postoperative acute rejection. Routine prophylactic antiviral treatment does not reduce the incidence of acute rejection due to infection-mediated immune damage.