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目的 :探讨包括撤减免疫抑制剂、使用免疫增强剂 (日达仙、丙种球蛋白 )、加用甲基强的松龙 (MP)在内的综合疗法治疗肾移植术后巨细胞病毒 (CMV)肺炎的疗效。 方法 :收集本中心 2 0 0 0年 10月～ 2 0 0 4年 4月间 4 1例肾移植术后CMV肺炎患者 ,在抗病毒治疗的基础上给予撤减免疫抑制剂 ,部分重症患者加用日达仙 ,胸腺肽α1、丙种球蛋白及MP等。动态观察外周血淋巴细胞计数 (PLC)和 (CD38+ CD8+ ) /CD8+ 比值的变化。 结果 :4 1例患者中 ,死亡 11例 (2 6 83% ) ,其中 4例因药物毒性和排斥反应导致移植肾功能衰竭后自动放弃治疗 ;7例死于呼吸、循环功能衰竭。 30例存活 ,血肌酐稳定在 112～ 175 (133± 38 4 ) μmol/L。 4 1例患者中 ,近期加用MP治疗者 8例 ,其中 1例因并发气胸死于呼吸循环功能衰竭 ,余 7例病情好转、血肌酐稳定 ;与早期 33例患者相比 ,此8例死亡率和移植肾失功率明显降低 (P <0 0 5 )。与治疗前相比 ,综合治疗后的PLC升高 (P <0 0 5 ) ,(CD38+CD8+ ) /CD8+ 比值下降 (P <0 0 5 )。 结论 :应用包括撤减免疫抑制剂、使用免疫增强剂、加用MP在内的综合疗法治疗肾移植术后CMV肺炎 ,效果较好 ;动态监测PLC和 (CD38+ CD8+ ) /CD8+ 比值变化 ,对调整CMV肺炎患者的免疫用药方案有一定
OBJECTIVE: To investigate the efficacy of cytomegalovirus (CMV) after renal transplantation, including the combination therapy of withdrawal of immunosuppressive agents, the use of immunostimulants (Zadaxin, gammaglobulin) and methylprednisolone (MP) The efficacy of pneumonia. Methods: A total of 41 patients with CMV pneumonia after renal transplantation were collected from October 2000 to April 2004 in our center. Anti-viral therapy was given based on the withdrawal of immunosuppressive agents, some patients with severe disease Daydaxian, thymosin α1, gamma globulin and MP and so on. The changes of peripheral blood lymphocyte count (PLC) and (CD38 + CD8 +) / CD8 + ratio were observed dynamically. Results: Of the 41 patients, 11 died (2683%), of which 4 were given up for renal failure due to drug toxicity and rejection, and 7 died of respiratory failure and circulatory failure. Thirty patients survived and serum creatinine remained stable at 112-175 (133 ± 384) μmol / L. Among the 4 patients, 8 were treated with MP recently, of which 1 died of respiratory failure due to concurrent pneumothorax, and the remaining 7 were improved and serum creatinine was stable. Compared with the early 33 patients, 8 died Rate and graft failure rate was significantly lower (P <0 05). After treatment, PLC increased (P <0.05) and the ratio of (CD38 + CD8 +) / CD8 + decreased compared with that before treatment (P <0.05). CONCLUSIONS: CMV pneumonia after renal transplantation is better than other immunotherapy including immunosuppressant, immunostimulant and MP, and the ratio of PLC and (CD38 + CD8 +) / CD8 + CMV pneumonia in patients with immunization programs have a certain