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目的总结肾移植术后巨细胞病毒性(CMV)重症肺炎的发病特点和诊治对策。方法回顾性分析6例肾移植术后CMV重症肺炎患者的发病经过、入院前后的临床表现、各种辅助检查、治疗过程和预后的相关临床资料。结果6例患者发病特点相似,包括:术后1~3月发病;主要症状为发热、咳嗽,基本无痰,发热早期憋气症状不明显;外周血白细胞正常或偏低,血清CMVpp65最后均为阳性;发热7~10d后,肺部出现炎性浸润灶,发展迅速,以间质性病变为主;肺部感染加重时,肾功能随之恶化;6例患者均经历了多种抗菌药物、糖皮质激素和机械通气等治疗;第3~6例患者CMV病原学诊断较早,并进行了较长时间的抗CMV病毒和激素维持治疗,最后存活,前2例患者死亡,死亡原因为顽固性低氧血症和急性肾功能衰竭。结论CMV重症肺炎具有相似的发病特点;早期明确病原学诊断、坚持抗CMV病毒和糖皮质激素维持治疗是成功治疗的关键。
Objective To summarize the characteristics and diagnosis and treatment of cytomegalovirus (CMV) severe pneumonia after renal transplantation. Methods The clinical data of 6 cases of CMV severe pneumonia after renal transplantation were analyzed retrospectively. The clinical manifestations, various auxiliary examinations, treatment courses and prognosis were retrospectively analyzed. Results The incidence of 6 patients was similar, including: onset from 1 to 3 months after operation; the main symptoms were fever, cough, no sputum and no obvious symptoms of suffocation during early fever; peripheral leukocytes were normal or low, serum CMVpp65 was finally positive ; 7 ~ 10d after fever, inflammatory infiltration of the lung focus, the rapid development of interstitial lesions mainly; lung infection aggravate, aggravate renal function; 6 patients have experienced a variety of antibacterial drugs, sugar Corticosteroids and mechanical ventilation and other treatment; 3 to 6 cases of CMV etiology diagnosis earlier, and for a longer period of anti-CMV virus and hormone maintenance treatment, and finally survived, the first two patients died and the cause of death was intractable Hypoxemia and acute renal failure. Conclusions CMV severe pneumonia has similar characteristics of onset. Early clear etiological diagnosis, adherence to anti-CMV virus and glucocorticoid maintenance therapy are the keys to successful treatment.