肝移植术后巨细胞病毒性肺炎的临床特点和治疗方法

目的 探讨肝移植术后巨细胞病毒（CMV）性肺炎的临床特点和治疗方法。方法 回顾性分析2003年10月至2005年6月间施行肝移植的451例患者的临床资料，对肝移植术后CMV性肺炎的临床特点和治疗方法进行总结。结果 在451例患者中，发生CMV性肺炎7例，感染率为1．66％。CMV性肺炎的症状明显早于体征，7例患者均无明显诱因出现高热，约1周后逐渐出现干咳、气促、呼吸困难等；血氧饱和度降低，血气分析提示低氧血症；CMV pp65抗原检测均为阳性。CMV性肺炎患者采用更昔洛韦联合膦甲酸钠抗病毒治疗，同时采取停用免疫抑制剂、加用较大剂量的丙种球蛋白和适量的胸腺肽等的个体化免疫调节方案以及广谱抗生素等综合治疗方法，6例治愈，治愈率为85．7％。结论 CMV性肺炎的早期临床表现虽然缺乏特异性，但仍有规律可循，CMV pp65抗原检测法具有特异性和敏感性高的特点。采取联合抗病毒和个体化免疫调节等综合措施治疗CMV性肺炎效果确切。

Clinical feature of cytomegalovirus pneumonia in orthotopic liver transplantation and treatments

Objective To study the clinical feature and treatment of cytomegalovirus(CMV) pneumonia in the orthotopic liver transplantation(OLT) recipients.Methods The clinical data of 451 patients after OLT in our hospital from Oct.2003 to June 2005 were retrospectively analyzed.The prevention,clinical feature and treatment of CMV pneumonia were discussed.Results Seven patients((1.66 %)) developed CMV pneumonia after OLT.The symptoms presented much earlier than signs.All patients had high fever,and followed with cough,polypnea,dyspnea one week later.Blood-gas analysis showed hypoxemia.CMV pp65 antigen detection was helpful for early diagnosis.All the infected patients received ganciclovir and foscarnet treatment.At the same time,immunosuppressive drugs were withdrawn and complex treatment including high dose immunoglobulin,low does thymulin and broad-spectrum antibiotec were given.Six patients((85.7 %)) were cured.Conclusions The early onset of CMV pneumonia is not specific but still regular.CMV pp65 antigen detection is specific and sensitive.Ganciclovir and foscarnet treatment is effective and complex therapy necessary for CMV pneumonia.