短程小剂量伐昔洛韦预防肾移植术后巨细胞病毒肺炎

目的评价短程小剂量伐昔洛韦预防肾移植术后巨细胞病毒(CMV)肺炎的有效性和安全性。方法2002年12月-2005年12月在我中心进行的首次同种异体尸体肾移植的患者中,接受CMV-IgG血清阳性供体的患者共157例。将入选患者随机分为3组,A组予短程小剂量伐昔洛韦(0.6 g,po,bid×2 mo,此后0.3 g,po,bid×1 mo)预防性治疗;B组予长程伐昔洛韦(0.6 g,po,bid×6 mo)预防性治疗;C组为空白对照组,即不进行预防性治疗。前瞻性观察肾移植术后1 a内各组中CMV肺炎的发病情况,包括发病率、发病潜伏期、发病时间及人/肾存活率。结果CMV肺炎发病率A组为13.46%,B组为14.81%,C组为35.30%,A、B组均低于C组,差异有统计学意义(P<0.05),但A、B组间差异无统计学意义(P>0.05)。结论短程小剂量伐昔洛韦可以有效降低肾移植术后CMV肺炎的发病率,与长程伐昔洛韦预防性治疗相比具有相同预防效果,且同样安全。     

更昔洛韦联合常乐康治疗婴幼儿轮状病毒肠炎临床观察

目的探讨更昔洛韦与常乐康联合治疗婴幼儿轮状病毒肠炎的效果。方法88例轮状病毒肠炎患儿随机分为更昔洛韦组,更昔洛韦+常乐康组,对照组三组。结果治疗3天总有效率更昔洛韦组,更昔洛韦+常乐康组,对照组分别为91.7%、92.9%、41.7%,差异有显著意义,(X2=26.33,P<0.01)组间比较显示更昔洛韦组,更昔洛韦+常乐康组总有效率明显高于对照组(X2=17.73,15.90,P<0.01),更昔洛韦+常乐康组总有效率与更昔洛韦组比较差异无显著意义(X2=0.09,P<0.05),但显效率(64.3%)明显高于更昔洛韦组的36.1%(X2=5.01,P<0.05),结论更昔洛韦与常乐康联合治疗婴幼儿轮状病毒肠炎疗效较好。     

更昔洛韦联合西咪替丁治疗婴幼儿轮状病毒肠炎临床观察

目的:探讨更昔洛韦与西咪替丁联合治疗婴幼儿轮状病毒肠炎的效果。方法:88例轮状病毒肠炎患儿随机分为更昔洛韦组、更昔洛韦+西咪替丁组、对照组三组。结果:治疗3d总有效率更昔洛韦组、更昔洛韦+西咪替丁组、对照组分别为91.7%、92.9%、41.7%,差异有显著意义(χ2=26.33,P<0.01)。组间比较显示,更昔洛韦组、更昔洛韦+西咪替丁组总有效率明显高于对照组(χ2=17.73、15.90,P<0.01);更昔洛韦+西咪替丁组总有效率与更昔洛韦组比较差异无显著意义(χ2=0.09,P>0.05),但显效率(64.3%)明显高于更昔洛韦组的36.1%(χ2=5.01,P<0.05)。结论:更昔洛韦与西咪替丁联合治疗婴幼儿轮状病毒肠炎疗效较好,值得临床应用。     

阿昔洛韦与更昔洛韦治疗成人水痘的疗效比较

目的:比较阿昔洛韦与更昔洛韦治疗成人水痘的疗效。方法:将我院140例水痘患者,按住院单双日随机均分为阿昔洛韦组与更昔洛韦组,分别给予阿昔洛韦与更昔洛韦10mg.kg-1,bid,静脉滴注。观察并记录2组患者的退热时间、皮疹结痂时间、总有效率和不良反应。结果:更昔洛韦组患者的退热时间明显短于阿昔洛韦组,2组比较差异有统计学意义(P<0.05);2组的皮疹结痂时间比较,差异无统计学意义(P>0.05);更昔洛韦组的总有效率明显高于阿昔洛韦组(P<0.05)。2组治疗过程中,均未见不良反应发生。结论:更昔洛韦治疗成人水痘的疗效显著优于阿昔洛韦,且退热时间短于阿昔洛韦。     

膦甲酸钠与更昔洛韦治疗获得性免疫缺陷综合征相关巨细胞病毒感染的安全性比较

目的 比较膦甲酸钠与更昔洛韦治疗获得性免疫缺陷综合征(AIDS)合并巨细胞病毒(CMV)感染的安全性,为临床安全合理用药提供参考.方法 将315例AIDS合并CMV感染患者分为膦甲酸钠组(155例)和更昔洛韦组(160例),治疗后比较其安全性.结果 膦甲酸钠可引起局部麻木、抽搐及电解质异常,更昔洛韦常致骨髓抑制及胃肠道...     

口服抗病毒新药——缬更昔洛韦

缬更昔洛韦 (valganciclovir)是抗病毒药更昔洛韦的前体药物 ,用于治疗AIDS病人发生的巨细胞病毒 (CMV)视网膜炎。缬更昔洛韦口服后迅速吸收 ,并水解为更昔洛韦 ,其口服给药的生物利用度较高 (60 % )。试验表明 ,口服缬更昔洛韦 (90 0mg)与静脉注射更昔洛韦 (5mg·kg-1) ,bid,3wk后改为 qd ,治疗 1 60例AIDS病人发生的CMV视网膜炎有相同疗效 ,且耐受性相似。缬更昔洛韦维持治疗中最常见的不良反应为中性粒细胞减少症、贫血、胃肠道反应 (腹泻、恶心、呕吐 )、发热、头痛和失眠等     

胸腺五肽联合盐酸伐昔洛韦治疗复发性生殖器疱疹的疗效观察

目的:观察胸腺五肽联合盐酸伐昔洛韦治疗复发性生殖器疱疹的疗效。方法:选取复发性生殖器疱疹患者62例,随机分为治疗组、对照组,2组患者的年龄、性别、病史、临床表现等方面比较,差异无显著性。治疗组口服盐酸伐昔洛韦分散片,300 mg/次,bid,同时给予胸腺五肽注射液10 mg皮下注射,隔日一次;对照组口服盐酸伐昔洛韦分散片,300 mg/次,bid。2组治疗时间均为3个月。结果:治疗后随访6个月,与对照组相比,治疗组复发间隔时间非常显著长于对照组(P<0.01),复发皮损面积显著小于对照组(P<0.05),皮损痊愈时间非常显著短于对照组(P<0.01),复发频率非常显著小于对照组(P<0.01)。结论:盐酸伐昔洛韦联合胸腺五肽治疗复发性生殖器疱疹疗效好,复发率低,无明显不良反应。     

伐昔洛韦联合甲钴胺对三叉神经痛球囊压迫术后单纯疱疹发生的影响

目的 评估伐昔洛韦联合甲钴胺对三叉神经痛球囊压迫术后单纯疱疹发生的影响。方法 分析2019年6月至2022年7月赣州市人民医院疼痛科诊断原发性三叉神经痛患者315例,均行经皮穿刺球囊压迫术（Percutaneous balloon compression,PBC）,根据围手术期是否预防使用抗病毒药物,分成3组,常规组（n=97）、伐昔洛韦组（n=110）、伐昔洛韦联合甲钴胺组（n=108）。记录3组患者术后发生疱疹的例数、发生时间、发生部位、疱疹持续时间、脱痂时间以及术后疱疹期疼痛评分（Visual Analogue Method,VAS）最大值。结果 3组患者共有93例患者在术后2～3 d发生单纯疱疹,常规组66例（68.04%）,主要发生在口周、面颊部、额头及眼周;伐昔洛韦组19例（17.27%）,主要以口周及面颊为主;伐昔洛韦联合甲钴胺组8例（7.41%）,主要发生在口周;伐昔洛韦联合甲钴胺组发生率要明显低于其他两组,3组疱疹发生率比较具有统计学意义（P <0.05）。联合组疱疹持续时间、脱痂时间早于其他两组,差异具有统计学意义（P <0.05）。3组疱疹发生后VAS...     

施保利通对巨细胞病毒感染小鼠唾液腺病毒滴度的影响

目的:探讨施保利通对巨细胞病毒(CMV)感染小鼠唾液腺中CMV滴度的影响。方法:建立全身播散性鼠巨细胞病毒(MCMV)感染小鼠模型,随机分为模型对照组、施保利通组、更昔洛韦组及联合治疗组,另设正常对照组,每组25只。应用细胞病变效应(CPE)法检测各组小鼠唾液腺MCMV感染性病毒滴度并比较其变化。结果:感染病毒后模型对照组小鼠唾液腺MCMV感染性病毒滴度逐渐升高,第14天达高峰;其他各组先迅速升高,第7天后,施保利通组未再有明显变化,更昔洛韦组及联合治疗组均降低。第14天时施保利通组病毒滴度明显低于模型对照组,但较更昔洛韦组高,两组比较差异有统计学意义(F=117.54,P<0.05),联合治疗组未检测到MCMV。各组峰值比较,施保利通组和更昔洛韦组低于模型对照组,高于联合治疗组,差异均有统计学意义(F=45.06,P<0.01)。结论:施保利通可降低小鼠唾液腺中MCMV感染性病毒滴度,与更昔洛韦联合用药可增加抗病毒疗效,具有协同作用。     

更昔洛韦治疗新生儿先天性巨细胞病毒感染临床效果观察

目的观察更昔洛韦在治疗新生儿先天性巨细胞病毒（CMV）感染上的疗效。方法将69例先天性CMV感染患儿随机分成3组,更昔洛韦组及丙种球蛋白组各27例、对照组15例。更昔洛韦组在常规治疗基础上加用更昔洛韦,诱导阶段：5mg／kg,静脉泵入,2次／d,连用14d,维持阶段：5mg／kg,1次／d,连用7d。丙种球蛋白组在常规治疗及应用更昔洛韦基础上加用丙种球蛋白400mg／kg,1次／d,连续应用3d。对照组予以常规治疗。结果治疗结束后,对患儿临床表现、实验室检查结果进行比较,各治疗组与对照组比较差异有统计学意义（P〈0．05）。结论应用更昔洛韦治疗先天性巨细胞病毒感染安全、有效、经济。     

达利珠单抗在肾移植术后预防急性排斥反应中的应用

目的 :观察达利珠单抗在预防肾移植术后急性排斥反应中的作用。方法 :36例病人分为 3组 ,A组 14例给予达利珠单抗 2次 ,B组 7例给予达利珠单抗 5次 ,C组 15例为对照组 ,观察急性排斥反应的发生情况、移植肾功能、巨细胞病毒感染率及不良反应 ,时间为 6mo。结果 :3组急性排斥反应发生率分别为 2 9% ,2 9% ,73% ,A ,B组与C组比较差异有显著意义 (P <0 .0 5 ) ,但A ,B组间比较差异无显著意义 (P >0 .0 5 )。首次出现急性排斥反应的时间分别为 65d ,70d ,4 8d ,术后 1,6moA ,B组移植肾功能优于C组 (P <0 .0 5 )。胃肠道不适及巨细胞病毒感染发生率 3组比较差异无显著意义 (P >0 .0 5 )。结论 :达利珠单抗可以降低急性排斥反应的发生率 ,改善移植肾功能 ,无明显不良反应 ,给予 2次与 5次的治疗效果相似 ,是安全有效的免疫抑制剂     

Cost-effectiveness model of cytomegalovirus management strategies in renal transplantation. Comparing valaciclovir prophylaxis with current practice

BACKGROUND: Cytomegalovirus (CMV) disease may occur following renal transplantation and has been shown to have health and cost consequences in this setting. OBJECTIVE: To compare the cost effectiveness of different CMV management strategies for renal transplant patients: prophylaxis with (i) oral valaciclovir or (ii) intravenous ganciclovir; viral testing for CMV followed by (iii) pre-emptive therapy with intravenous ganciclovir or (iv) adjustment of immunosuppression and intensive monitoring; or (v) waiting to treat when CMV disease develops. METHODS: A decision-tree model was constructed that included the different management strategies for the donor seropositive/recipient seronegative (D+R-) population. Clinical outcomes for the D+R- population came from clinical trials. Treatment algorithms and costs for CMV syndrome and tissue invasive disease were developed from published literature and UK physician interviews. One- and 2-way sensitivity analyses were performed. STUDY PERSPECTIVE: UK National Health Service. RESULTS: Prophylaxis with either oral valaciclovir or intravenous ganciclovir dominated (lower costs and fewer cases of CMV disease) the pre-emptive treatment and wait-and-treat strategies. The cost per patient was from 157 Pounds to 438 Pounds higher with oral valaciclovir prophylaxis compared with intravenous ganciclovir prophylaxis and the incremental cost per case of CMV disease avoided with valaciclovir prophylaxis ranged from 2243 Pounds to 8111 Pounds (1996 values). These results are sensitive to the efficacy of intravenous ganciclovir prophylaxis and CMV management costs. CONCLUSIONS: For D+R- renal transplant patients, prophylaxis is the dominant (more effective and less costly) management strategy compared with pre-emptive and wait-and-treat strategies. The cost per patient with oral valaciclovir prophylaxis compared with intravenous ganciclovir prophylaxis is slightly higher in our base case scenario, but may be lower under reasonable alternative assumptions.     

Prophylaxis of herpesvirus infections in immunocompetent and immunocompromised older patients

In older patients, prophylaxis of herpesvirus infections mainly involves preventing the recurrence of herpes simplex virus (HSV) and complications of herpes zoster in immunocompetent patients, while in immunocompromised patients it is more concerned with the prevention of opportunistic virus reactivation. HSV ocular infection is the most frequent cause of corneal blindness in the US. The effectiveness of aciclovir 400mg twice daily in preventing the recurrence of HSV eye disease in immunocompetent patients has been well demonstrated. The issue of treatment duration for patients with highly recurrent ocular herpes remains unresolved. Post-herpetic neuralgia (PHN) is one of the most common neuralgic illnesses worldwide. Some progress in prevention of PHN has been made with a combination of antiviral therapy (famciclovir or valaciclovir), started within 72 hours of onset of the rash, and analgesic treatment. However, the best prevention of PHN is the prevention of herpes zoster disease, and the varicella vaccine is an option which over the next few years will be tested in clinical trials. For immunocompromised patients of any age, restoring immunity prevents herpesvirus disease, as demonstrated for cytomegalovirus (CMV) in AIDS patients receiving highly active antiretroviral therapy. Specific antiviral therapy during the initial period after transplantation could prevent reactivation of HSV or CMV in seropositive recipients. Whether pre-emptive therapy or prophylaxis with ganciclovir is the optimal approach against CMV remains controversial, and the relative merits and limitations of each approach may guide the choice. In stem cell transplantation, pre-emptive therapy with foscarnet avoids the neutropenia and related complications associated with ganciclovir. In renal transplant recipients, universal prophylaxis of CMV infection with valaciclovir has the same efficacy as ganciclovir. Although it is relatively toxic, cidofovir should be further evaluated because of its in vitro activity against most DNA viruses.     

Prophylaxis against herpesvirus infections in transplant recipients

Herpesvirus infections are important after stem cell and organ transplant. During the last decades several antiviral agents have been introduced with efficacy against herpesviruses. These agents are the nucleoside analogues aciclovir, valaciclovir, famciclovir, and ganciclovir; the nucleotide analogue cidofovir; and the pyrophosphate analogue foscarnet. Several studies have been performed with antiviral agents with the aim to reduce morbidity and mortality associated with herpesvirus infections in transplant recipients. Aciclovir and valaciclovir have been examined in randomised, controlled trials in both solid organ and stem cell transplant patients, and were shown to be very effective for the prevention of herpes simplex virus (HSV) and varicella-zoster virus infections. In addition, these drugs were shown to reduce cytomegalovirus (CMV) infection and improve survival in allogenic stem cell transplant patients and to reduce CMV infection, CMV disease (aciclovir and valaciclovir), and acute rejection (valaciclovir) in renal transplant patients. Ganciclovir is very effective for the prevention of CMV infection and disease in both stem cell and solid organ transplant recipients. It can also be used in preemptive strategies in which the aim is to prevent CMV disease in patients who have ongoing CMV infection documented by antigenaemia or detection of CMV DNA. The latter strategy has the advantage of reducing the exposure to the drug and thereby the risk for toxicity. Foscarnet has also been shown to be effective as preemptive therapy for CMV in allogenic stem cell transplant patients and as therapy for aciclovir-resistant HSV infections. Finally cidofovir is an interesting agent with broad spectrum antiherpesvirus efficacy. However, because of the drug's toxicity profile, further studies are needed.     

Current management strategies for the prevention and treatment of cytomegalovirus infection in pediatric transplant recipients

Cytomegalovirus (CMV) is a significant cause of morbidity and mortality following transplantation, especially in the pediatric population, who remain at high risk of primary infection. The availability of effective antiviral therapy has led to dramatic improvements in the outcome of CMV infection in patients undergoing transplantation. In recent years, three major strategies have been developed for the prevention of CMV disease in this population: reduction of risk of viral acquisition or reactivation by management of risk factors; prophylaxis of all 'at-risk' patients using prophylactic strategies for a defined period of time, initiated at or near the time of transplant; and pre-emptive treatment with ganciclovir of selected 'at-risk' patients, guided by either laboratory markers indicative of subclinical infection or the presence of specific risk factors. In general, well designed comparative studies of one or more antiviral agents for the prevention of CMV have not been carried out. While ganciclovir appears to be more effective than aciclovir, its tolerability profile is less optimal. The use of foscarnet avoids myelosuppresions, but is associated with significant nephrotoxicity. Its use should be reserved for patients unable to tolerate ganciclovir or with ganciclovir-resistant CMV disease. Similar to foscarnet, the high frequency of nephrotoxicity associated with the use of cidofovir limits its use to clinical scenarios suggestive of ganciclovir resistance. Newer options, such as valaciclovir and valganciclovir, are currently under investigation and preliminary experience has been promising. Finally, passive immunoprophylaxis has been shown to prevent CMV disease after solid organ transplantation, but its use in bone marrow transplantation is controversial. Essentially, pre-emptive strategies have relied on the quantitation in the peripheral blood of CMV phosphoprotein pp65 antigen and/or the polymerase chain reaction assay. Strict guidelines for the use of those assays as a guide to pre-emptive therapy have not been standardized. Prospective trials comparing pre-emptive therapy using either intravenous or oral ganciclovir, and now oral valganciclovir or valaciclovir, are necessary to determine the relative cost effectiveness and efficacy of these alternative strategies. Finally, it remains controversial as to whether prophylaxis or pre-emptive therapy is the optimal strategy for preventing CMV disease. While a growing body of literature describes these approaches in adult transplant recipients, published experience in children has been much more limited.     

Immune monitoring of anti cytomegalovirus antibodies and risk of cytomegalovirus disease in heart transplantation

We sought to determine whether quantitative assessment of anti-cytomegalovirus (CMV) antibodies could be useful to identify patients at risk of cytomegalovirus (CMV) disease after heart transplantation (HT). 75 patients who underwent HT at a single health care center were prospectively studied. Induction therapy included 2 doses of daclizumab and maintenance tacrolimus (n=42) or cyclosporine (n=29), mycophenolate mofetil and prednisone. All patients received prophylaxis with gancyclovir or valganciclovir. Anti-CMV intravenous immunoglobulin (CMV-IG) was added in high risk patients (CMV D+/R- serostatus). Serial determinations of anti-CMV antibodies, immunoglobulins (IgG, IgA, IgM) and IgG-subclasses were analysed. CMV infection was based on detection of the virus by antigenemia. CMV disease consisted of detection of signs or symptoms attributable to this microorganism. Ten patients (13.3%) developed CMV disease. Mean time of development of CMV disease was 3.4+/-1.6 months. In Cox regression analysis, patients with low baseline anti-CMV titers (<4.26 natural logarithm of titer, RH: 8.1, 95%CI: 1.93-34.1, p=0.004) and recipients with 1-month post-HT IgG hypogammaglobulinemia (IgG<500 mg/dl, RH: 4.49, 95%CI: 1.26-15.94, p=0.02) were at higher risk of having CMV disease. Despite use of prophylactic CMV-IG, D+/R- patients showed significantly lower titers of anti-CMV antibodies at 7 d, 30 d and 90 d post HT as compared with HT recipients without infections. Four out of 6 of these patients developed late CMV disease. Monitoring of specific anti-CMV antibodies on the bedside warrants further evaluation as a potential tool to identify heart transplant recipients at higher risk of CMV disease.     

Valaciclovir: a review of its long term utility in the management of genital herpes simplex virus and cytomegalovirus infections

Valaciclovir is an aciclovir prodrug used to treat infections caused by herpes simplex virus (HSV) and varicella zoster virus, and for prophylaxis against cytomegalovirus (CMV). Oral valaciclovir provides significantly better oral bioavailability than oral aciclovir itself, contributing to the need for less frequent administration. Several studies have demonstrated the efficacy of long term (> 90 days) therapy with valaciclovir for the suppression of genital HSV disease in otherwise healthy individuals with HSV infection. In 1 randomised, double-blind trial, once daily valaciclovir (1000 mg, 500 mg and 250 mg) produced statistically significant suppression of disease recurrence, as did twice daily valaciclovir 250 mg and aciclovir 400 mg. Valaciclovir dosages of > or = 500 mg daily are recommended for suppression of genital herpes recurrences in immunocompetent individuals. This disease occurs frequently in patients with human immunodeficiency virus (HIV) infection and, in a single randomised double-blind trial, prophylactic valaciclovir (1000 mg once daily or 500 mg twice daily) and aciclovir (400 mg twice daily) were found to be of similar efficacy in the suppression of genital herpes. However, a higher than expected dropout rate indicated that more studies of valaciclovir in patients with HIV are required. In a randomised trial of patients undergoing renal transplant, valaciclovir 2 g 4 times daily for 90 days significantly reduced the incidence and delayed the onset of CMV disease: the incidence in valaciclovir-treated patients who were CMV-seronegative at baseline, and recieived a kidney from a CMV-seropositive donor, was 3% versus 45% for placebo after 90 days of treatment. Acute graft rejection was also reduced in the valaciclovir-treated group. A small study in heart transplant patients compared valaciclovir (2 g 4 times daily) with aciclovir (200 mg 4 times daily) and found a significant reduction in CMV antigenaemia favouring valacilovir at the end of the treatment period. Additional reductions in other indices of CMV in those given valaciclovir compared with aciclovir were also noted. In a preliminary study of prophylaxis for CMV disease in bone marrow transplant recipients valaciclovir (2 g 4 times daily) was superior to aciclovir (800 mg 4 times daily) in terms of time to CMV viraemia or viruria. Although valaciclovir (8 g/day for approximately 30 weeks) reduced the incidence and time to CMV disease compared with aciclovir (3.2 g/day) in patients with advanced HIV disease, valaciclovir was associated with more gastrointestinal complaints and an increased risk of death, leading to premature termination of the study. As yet, no trials comparing the efficacy of valaciclovir with famciclovir (the oral prodrug for penciclovir) in the suppression of recurrent episodes of genital herpes have been published, nor have direct comparisons been made, between valaciclovir with ganciclovir in patients with CMV disease. Valaciclovir is well tolerated at dosages used to suppress recurrent episodes of genital herpes (500 to 1000 mg/day) in immunocompetent and HIV seropositive individuals, with headache being reported most often. However, a potentially fatal thrombotic microangiopathy (TMA)-like syndrome has been reported in some immunocompromised patients receiving high-dose prophylactic valaciclovir therapy (8 g/day) for CMV disease for prolonged periods, and the risk of this syndrome appears to be higher in patients with advanced HIV disease. While the clinical benefits of valaciclovir in some immunocompromised patients may outweigh the risk of TMA, close monitoring for symptoms of TMA is indicated in all immunocompromised patients receiving high-dose valaciclovir. Conclusion: Oral valaciclovir is an effective drug for the suppression of recurrent episodes of genital herpes in immunocompetent and immunocompromised individuals. (ABSTRACT TRUNCATED)     

膦甲酸钠治疗肾移植后巨细胞病毒抗原血症25例

目的：评估膦甲酸钠(PFA)治疗肾移植巨细胞病毒抗原(CMV-PP65抗原)血症的临床疗效和不良反应。方法：50例CMV-PP65抗原阳性肾移植病人分为治疗组和对照组,各25例。治疗组用PFA 60 mg·kg~(-1)·d~(-1),iv,gtt,疗程2～4 wk,对照组不使用抗病毒药物。结果：治疗组用药后显效20例(80%),有效3例(12%),无效2例(8%),显效、有效病例随访6 mo CMV-PP65抗原无转阳,对照组随访6 mo无一例CMV-PP65抗原阴转。治疗组治疗后CMV-PP65抗原阳性细胞数下降了(52±s 21)个·5万~(-1) WBC,与治疗前比较差异非常显著(P＜0．01)；对照组观察开始和结束时CMV-PP65抗原阳性细胞数无明显变化(P＞0．05),2组差异非常显著(P＜0．01)。PFA的不良反应为胃肠不适、低钙、低钾及一过性血肌酐升高。结论：PFA可以有效清除肾移植CMV-PP65抗原,不良反应轻微。     

Comparison of ganciclovir- and immune globulin-containing regimens in preventing cytomegalovirus infection in patients with renal transplants.

The effectiveness and costs of ganciclovir compared with intravenous immune globulin (IVIG) in the prevention of cytomegalovirus (CMV) disease were studied. A retrospective analysis was conducted of renal transplant patients treated with ganciclovir during the initial hospital stay followed by three months of acyclovir therapy and a historical control group that received IVIG at one, two, four, six, and eight weeks posttransplant and acyclovir at two weeks posttransplant and continued for three months. The average drug cost for each regimen and the average direct cost of treating CMV disease in each group were calculated. The overall frequency of CMV disease was 14% in the IVIG group (n = 42) and 3% in the ganciclovir group (n = 30). CMV disease occurred less frequently in all ganciclovir-treated subgroups, but the difference was significant only in the group in which the recipient was CMV seronegative and the donor CMV seropositive. No ganciclovir-related adverse events were noted. Three IVIG-related infusion reactions were noted. Treatment with ganciclovir decreased drug costs by approximately $2,775 per patient or $83,250 for the study sample. The overall avoided cost in the ganciclovir group was $102,575 ($3,419 per patient). Ganciclovir followed by acyclovir was significantly more effective than IVIG followed by acyclovir in the prevention of CMV disease in CMV-seronegative patients who received renal transplants from CMV-seropositive donors; among all patients studied, ganciclovir did not differ from IVIG in preventing CMV infection but was considerably less expensive.