更昔洛韦治疗婴儿巨细胞病毒性肝炎疗效观察

目的探讨更昔洛韦对婴儿巨细胞病毒（CMV）性肝炎的疗效及副作用。方法2004年1月至2005年4月于我院住院58例婴儿CMV肝炎更昔洛韦治疗前后血清总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、碱性磷酸酶（AKP）、r-谷氨酰转肽酶（r-GT）的变化，观察药物不良反应。结果更昔洛韦治疗后血清TBIL、ALT水平下降，肝脾回缩，所有指标的差异均有显著性（P均〈0．01），更昔洛韦治疗组中出现白细胞下降及血小板降低的比例分别为40％、30％。结论更昔洛韦治疗巨细胞病毒性肝炎疗效好，为一较理想药物，但要注意该药对白细胞和血小板的影响。     

更昔咯韦治疗婴儿巨细胞病毒性肝炎疗效观察

目的 探讨更昔洛韦对婴儿巨细胞病毒(CMV)性肝炎的疗效及副作用.方法 2004年1月至2005年4月于我院住院58例婴儿CMV肝炎更昔洛韦治疗前后血清总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(AKP)、r-谷氨酰转肽酶(r-GT)的变化,观察药物不良反应.结果 更昔洛韦治疗后血清TBIL、ALT水平下降,肝脾回缩,所有指标的差异均有显著性(P均＜0.01),更昔洛韦治疗组中出现白细胞下降及血小板降低的比例分别为40%、30%.结论 更昔洛韦治疗巨细胞病毒性肝炎疗效好,为一较理想药物,但要注意该药对白细胞和血小板的影响.     

更昔洛韦治疗新生儿先天性症状性巨细胞病毒感染

目的应用不同剂量更昔洛韦（GCV）治疗新生儿先天性症状性巨细胞病毒（CMV）感染,观察临床疗效和不良反应,评价其治疗效果和安全性。方法先天性症状性CMV感染新生儿37例随机分为高剂量治疗组（n=19）和低剂量治疗组（n=18）,其中高剂量治疗组予GCV的剂量为：诱导治疗每次7．5mg／kg,维持治疗每次10mg／kg;低剂量治疗组予GCV的剂量：诱导治疗每次5mg／kg,维持治疗每次5mg／kg。观察两组的临床疗效和不良反应。结果不同剂量的GCV治疗先天性症状性CMV感染后临床症状均有所好转,高剂量治疗组CMV—IgM转阴率89．5％,CMV—DNA转阴率73．7％;低剂量治疗组CMV—IgM转阴率83．3％,CMV—DNA转阴率为77．8％,两组比较差异无统计学意义。低剂量GCV治疗先天性症状性CMV感染新生儿的不良反应低于高剂量GCV,低剂量治疗组中性粒细胞减少、贫血、血小板减少发生率低于高剂量治疗组,两组比较差异有统计学意义（P〈0．05）。结论低剂量GCV治疗新生儿先天性症状性CMV感染与高剂量有同样的临床疗效,且不良反应低于高剂量GCV。     

更昔洛韦治疗新生儿先天性症状性巨细胞病毒感染

目的 应用不同剂量更昔洛韦(GCV)治疗新生儿先天性症状性巨细胞病毒(CMV)感染,观察临床疗效和不良反应,评价其治疗效果和安全性.方法 先天性症状性CMV感染新生儿37例随机分为高剂量治疗组(n=19)和低剂量治疗组(n=18),其中高剂量治疗组予GCV的剂量为:诱导治疗每次7.5 mg/kg,维持治疗每次10 mg/kg;低剂量治疗组予GCV的剂量:诱导治疗每次5mg/kg,维持治疗每次5 mg/kg.观察两组的临床疗效和不良反应.结果 不同剂量的GCV治疗先天性症状性CMV感染后临床症状均有所好转,高剂量治疗组CMV- IgM转阴率89.5％,CMV-DNA转阴率73.7％;低剂量治疗组CMV-IgM转阴率83.3％,CMV-DNA转阴率为77.8％,两组比较差异无统计学意义.低剂量GCV治疗先天性症状性CMV感染新生儿的不良反应低于高剂量GCV,低剂量治疗组中性粒细胞减少、贫血、血小板减少发生率低于高剂量治疗组,两组比较差异有统计学意义(P＜0.05).结论 低剂量GCV治疗新生儿先天性症状性CMV感染与高剂量有同样的临床疗效,且不良反应低于高剂量GCV.     

更昔洛韦治疗新生儿巨细胞病毒感染临床疗效分析

目的 观察更昔洛韦治疗新生儿巨细胞病毒感染临床疗效,并总结治疗效果.方法 收集2007年10月至2012年12月在山东省莱芜市人民医院就诊的巨细胞病毒感染患儿100例.应用更昔洛韦治疗,观察疗效.结果 100例患儿中,治愈30例,症状好转56例,症状反复6例,放弃治疗8例.所有临床表现为肝功能损害的患儿经治疗后治愈或症状好转.分别有95.6％和95.0％临床表现为黄疸和支气管肺炎的患儿转归为治愈或症状好转.结论 更昔洛韦对巨细胞病毒感染儿童的肺炎、肝功能损害、黄疸有较为显著的疗效.制定科学合理的护理策略是进一步提高患儿康复的重要保障.     

更昔洛韦治疗疱疹性咽峡炎80例临床分析

目的 观察更昔洛韦治疗疱疹性咽峡炎的疗效。方法 将同期疱疹性咽峡炎的患儿156例随机分为治疗组（更昔洛韦）80例及对照组（病毒唑）76例进行比较。结果 治疗组再退热时间、疱疹消失时间均少于对照组（P〈0．01）。结论 更昔洛韦治疗疱疹性咽峡炎疗效显著，可以广泛应用。     

小儿巨细胞病毒性肝炎治疗的临床对照研究

目的　探讨小儿巨细胞病毒 (HCMV)肝炎的有效治疗方法。方法　将诊断为小儿HCMV肝炎的 2 5例分为治疗组和对照组 ,对照组给予泼尼松、肝太乐、消炎利胆片及苯巴比妥等 ,治疗组在此基础上给予更昔洛韦 (GCV) 静脉用免疫球蛋白 (IVIG) ,分别在治疗前、出院时检查血常规、肝功能和HCMVDNA拷贝数 ,并在出院后 3个月、6个月、9个月随访 ,检查患儿的症状、体征和HCMV定量。结果　治疗组在 5个时点 (治疗前、出院时、3个月、6个月、9个月 )HCMVDNA拷贝数明显下降 ,治疗组和对照组之间用药前后比较 ,在住院天数、黄疸开始消退时间及黄疸完全消退时间的差异有显著意义 ,治疗组输血率明显减少 (P <0 0 5 )。结论　GCV联合IVIG治疗小儿HCMV肝炎能明显降低病毒量 ,缩短病程 ,减轻症状 ,又可纠正贫血 ,减少输血机会 ,未见明显副作用。     

更昔洛韦治疗手足口病临床观察

目的通过对使用更昔洛韦治疗的手足口病患者的临床资料进行统计和研究,积累手足口病治疗的经验,加强对该病认识,积极控制疾病的流行。方法通过对173例使用更昔洛韦治疗的手足口病患者的临床及流行病学资料进行回顾性研究分析,把其流行病学资料、临床特征、治疗转归、肝功能与肾功能以及心肌酶学检查等结果加以总结。结果173例使用更昔洛韦治疗的手足口病患者中,平均年龄4．5岁。所有病例均有口腔粘膜、手掌、脚掌米粒大小疱疹,周围可见红晕,皮疹发生率为100％。均符合2008年《手足口病预防控制指南》中的手足口病诊断。经及时诊断和早期治疗后,在选取的173例使用更昔洛韦治疗的手足口病患者中,除1例住院1d即去上级医院就诊外,均获痊愈。     

丙种球蛋白治疗新生儿巨细胞病毒肺炎的临床疗效分析

目的探讨丙种球蛋白治疗新生儿巨细胞病毒感染性肺炎的疗效和安全性。方法回顾于2000年7月至2006年3月入院的24例新生儿巨细胞病毒感染性肺炎患儿,随机分为两组进行对照研究,入选患儿常规抗生素治疗,明确病原后予对因治疗,对照组应用更昔洛韦,每次5mg/kg,每12h1次,疗程14d;治疗组用静脉用丙种球蛋白每日400mg/kg,疗程10d。观察项目:①临床指标:住院天数、肺部体征开始消退时间。②实验室指标:血常规、肝功能、HCMV-DNA量的变化。③随访观察:出院后每3个月随访一次,包括临床表现、体征和FQ-PCR测定HCMV-DNA拷贝数。结果静脉用丙种球蛋白治疗组有效率81.8%,治疗组有效率53.8%,两组疗效相近,差异无统计学意义(χ2=2.329,P>0.05),治疗组平均住院日为(23±5.6)d,对照组为(28.6±7)d,差异有统计学意义(t=-2.164,P<0.05)。肺部体征开始消退天数分别为(7.45±1.37)d和(9.58±2.61)d,存在统计学差异(t=-2.415,P<0.05)。对照组有2例因WBC<0.5×109/L,plt<25×109/L,而终止治疗,1例治疗过程中死于呼吸衰竭。结论丙种球蛋白治疗新生儿巨细胞病毒感染性肺炎疗效与更昔洛韦相近,相对于更昔洛韦,在治疗新生儿巨细胞病毒感染性肺炎,特别是合并多种病原体混合感染,静脉用丙种球蛋白具有较好的疗效和安全性。     

Fatal reactivation of postnatal cytomegalovirus infection with rapid emergence of ganciclovir resistance in an infant after allogeneic stem cell transplantation

Human cytomegalovirus (HCMV) can cause serious problems after hematopoietic stem cell transplantation. The death of a pediatric transplant recipient after reactivation of a postnatal HCMV infection with bilateral retinitis and pneumonitis is described. Sequencing of the HCMV UL97 region revealed a compartment-specific mutation (H520Q) in urine conferring ganciclovir resistance.     

Oral ganciclovir for patients with cytomegalovirus retinitis treated with a ganciclovir implant. Roche Ganciclovir Study Group

BACKGROUND: The intraocular ganciclovir implant is effective for local treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome (AIDS), but it does not treat or prevent other systemic manifestations of cytomegalovirus infection. METHODS: Three hundred seventy-seven patients with AIDS and unilateral cytomegalovirus retinitis were randomly assigned to one of three treatments: a ganciclovir implant plus oral ganciclovir (4.5 g daily), a ganciclovir implant plus oral placebo, or intravenous ganciclovir alone. The primary outcome measure was the development of new cytomegalovirus disease, either contralateral retinitis or biopsy-proved extraocular disease. RESULTS: The incidence of new cytomegalovirus disease at six months was 44.3 percent in the group assigned to the ganciclovir implant plus placebo, as compared with 24.3 percent in the group assigned to the ganciclovir implant plus oral ganciclovir (P=0.002) and 19.6 percent in the group assigned to intravenous ganciclovir alone (P<0.001). As compared with placebo, oral ganciclovir reduced the overall risk of new cytomegalovirus disease by 37.6 percent over the one-year period of the study (P=0.02). However, in the subgroup of 103 patients who took protease inhibitors, the rates of new cytomegalovirus disease were low and of similar magnitude, regardless of treatment assignment. Progression of retinitis in the eye that initially received an implant was delayed by the addition of oral ganciclovir, as compared with placebo (P=0.03). Treatment with oral or intravenous ganciclovir reduced the risk of Kaposi's sarcoma by 75 percent (P=0.008) and 93 percent (P<0.001), respectively, as compared with placebo. CONCLUSIONS: In patients with AIDS and cytomegalovirus retinitis, oral ganciclovir in conjunction with a ganciclovir implant reduces the incidence of new cytomegalovirus disease and delays progression of the retinitis. Treatment with oral or intravenous ganciclovir also reduces the risk of Kaposi's sarcoma.     

Combined ganciclovir and foscarnet in pediatric cytomegalovirus retinitis.

Cytomegalovirus retinitis is the leading cause of blindness in adults and children with acquired immunodeficiency syndrome (AIDS). Although clinical trials on therapy exist for adults, management of cytomegalovirus retinitis in children is not as well-documented. This report describes the clinical course of a 3-year-old child with cytomegalovirus retinitis. After initial failure with single-agent ganciclovir intravenous treatment, early institution of combined treatment with foscarnet and ganciclovir halted progression of the retinitis. This case report highlights the aggressive nature of cytomegalovirus retinitis in children and the consideration of early combined therapy compared to adult patients.     

Randomized prospective trial of ganciclovir maintenance therapy for cytomegalovirus retinitis

We report the first randomized prospective comparative study of long-term maintenance ganciclovir (9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine, BW759U, DHPG) therapy for cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome (AIDS). Eleven retinitis patients who received a 10-day course of ganciclovir induction therapy and then were randomized to receive either immediate daily ganciclovir maintenance therapy or deferred maintenance (eight deferred maintenance, three immediate maintenance) were evaluated for drug efficacy. Median time to retinitis progression was 42 days for the immediate maintenance group compared with 16 days for the deferred maintenance group, (P = 0.07). After crossing over to maintenance therapy, patients in the deferred group had a median time to retinitis progression of 58 days compared to 16 days while not on maintenance therapy (P = 0.13). Only 9% of cultures obtained while patients received maintenance therapy were positive for cytomegalovirus, vs 40% of those obtained off maintenance (P less than 0.001). We can state then that maintenance therapy with ganciclovir delays, but does not halt, progression of cytomegalovirus retinitis and suppresses, but does not eradicate, cytomegalovirus shedding in patients with AIDS.     

Detection of ganciclovir resistance after valacyclovir-prophylaxis in renal transplant recipients with active cytomegalovirus infection

Whether valaciclovir (VCV) prophylaxis could be responsible for ganciclovir (GCV)-resistance of Human cytomegalovirus (HCMV) in transplantation has never been documented. A multicentric retrospective pilot study was undertaken to detect GCV-resistance through mutations within the UL97 gene in renal transplant recipients who experienced active HCMV infection and received valacyclovir prophylaxis. Twenty-three patients who experienced HCMV antigenaemia or DNAemia during or at the end of prophylaxis were included. UL97 genotyping was carried out on peripheral blood samples, using a nested in-house PCR, which amplified the full-length UL97 gene. One patient has a resistance-related mutation (M460I); the major risk factor for emergence of resistance in this patient was the presence of early and persistent antigenaemia. GCV-resistance during VCV-prophylaxis was rare after renal transplantation. However, special attention must be paid to patients developing early active HCMV infection under prophylaxis.     

Combined and alternating ganciclovir and foscarnet in acute and maintenance therapy of human immunodeficiency virus-related cytomegalovirus encephalitis refractory to ganciclovir alone

Summary Cytomegalovirus (CMV) causes life-threatening disseminated infections and in particular vision-threatening infections of the retina in patients with the acquired immunodeficiency syndrome. Ganciclovir currently represents the most frequently used therapy for CMV retinitis. However, cases of ganciclovir-resistant CMV strains have been described, in which foscarnet seems to be an effective alternative. Both drugs have serious toxicities, and relapses frequently occur during maintenance therapy. In a patient with CMV encephalitis, we administered a 3-week combination ganciclovir/foscarnet induction therapy (ganciclovir 5 mg/kg every 12 h; foscarnet 60 mg/kg every 8 h), followed by an alternating maintenance administration of both drugs every other day (ganciclovir 5 mg/kg, foscarnet 120 mg/kg) to reduce toxicity and resistance. This regimen was tolerated well and seemed to be more effective than ganciclovir alone in a patient with CMV encephalitis.Abbreviations AIDS acquired immunodeficiency syndrome - CMV cytomegalovirus - CNS central nervous system - CSF cerebrospinal fluid - CT computed tomography - ED50 50% effective dose - ELISA enzyme-linked immunosorbent assay - HIV human immunodeficiency virus - MRI magnetic resonance imaging     

Early treatment with ganciclovir to prevent cytomegalovirus disease after allogeneic bone marrow transplantation.

BACKGROUND. Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality after allogeneic bone marrow transplantation. We conducted a controlled trial of ganciclovir for the early treatment of CMV infection in asymptomatic recipients of bone marrow transplants whose surveillance cultures for CMV became positive. METHODS. Bone marrow--allograft recipients who were seropositive for CMV antibodies or who received seropositive marrow were screened for CMV excretion by culture of throat swabs, blood, urine, or bronchoalveolar-lavage fluid. In this double-blind trial, 72 patients who had marrow engraftment and were excreting virus were randomly assigned to receive either placebo or ganciclovir (5 mg per kilogram of body weight twice a day for one week, followed by 5 mg per kilogram per day) for the first 100 days after transplantation. Patients were followed for the development of biopsy-confirmed CMV disease, ganciclovir-related toxicity, and survival. RESULTS. Between assignment to the study drug and day 100 after transplantation, CMV disease developed in only 1 of the 37 patients assigned to receive ganciclovir (3 percent), but in 15 of the 35 patients assigned to receive placebo (43 percent, P less than 0.00001). The ganciclovir recipients had rapid suppression of virus excretion; 85 percent had negative cultures after one week of treatment, as compared with 44 percent of the placebo group (P = 0.001). The principal toxic reaction was neutropenia; 11 ganciclovir recipients had an absolute neutrophil count below 0.75 x 10(9) per liter, as compared with 3 placebo recipients (P = 0.052). Treatment was discontinued in 11 ganciclovir recipients and 1 placebo recipient because of neutropenia (P = 0.003). After treatment was stopped, the neutrophil count recovered in all patients. Overall survival was significantly greater in the ganciclovir group than in the placebo group both 100 days and 180 days after transplantation (P = 0.041 and 0.027, respectively). CONCLUSIONS. Early treatment with ganciclovir in patients with positive surveillance cultures reduces the incidence of CMV disease and improves survival after allogeneic bone marrow transplantation.