更昔洛韦及干扰素预防病毒性心肌炎疗效对比

近 3年来我们采用更昔洛韦或干扰素预防病毒性心肌炎(VM)复发 ,并对二者的疗效进行了对比 ,现报告如下。临床资料 :本组 10 8例 VM复发患儿 (男 :女为 1.14 :1) ,年龄 2～ 12岁。均按 1997年威海全国会议修订的标准确诊。病程为 6～ 18个月。入院前均有 2次以上复发 ,每次复发均有心肌酶谱和心电图异常。其中 CK- MB为 5 8.2 5± 10 .36 U /L、L DH1为 171.4 8± 2 5 .17U/L、c Tn I阳性者 6 1例 (6 1/75 ) ;心电图表现为明显心肌劳累 (84 /10 8)、 、av F导联 T波低平或倒置 (12 /10 8)、窦性心动过速 (7/10 8)。胸部 X线摄片均无…     

更昔洛韦联合醒脑静治疗病毒性脑炎疗效观察

目的观察更昔洛韦联合醒脑静治疗病毒性脑炎的临床疗效。方法将61例病毒性脑炎（VE）患者随机分成两组,联合组31例,病毒唑组30例。联合组应用更昔洛韦10mg/kg体质量静脉滴注,每8小时1次,并联合醒脑静320mg静脉滴注,1次/d;病毒唑组应用病毒唑10mg/kg静脉滴注,1次/d,疗程均为14d。结果两组治愈率更昔洛韦组87.1%,病毒唑组为63.3%,两组比较差别具有统计学意义（P〈0.05）。联合组在发热、头痛、呕吐、抽搐消失时间及神志恢复的时间上明显短于病毒唑组,差别具有统计学意义（P〈0.01）。结论更昔洛韦联合醒脑静治疗病毒性脑炎疗效显著。     

更昔洛韦治疗儿童单纯疱疹病毒性脑炎35例疗效观察

单纯疱疹病毒性脑炎(HSE)是由单纯疱疹病毒(HSV)引起的一种急性中枢神经系统感染性疾病，是儿童散发性病毒性脑炎中常见且预后最差的类型。2001年6月至2004年1月,我们应用更昔洛韦治疗儿童单纯疱疹病毒性脑炎35例，疗效较好。现报告如下。     

更昔洛韦治疗小儿病毒性脑炎83例

2004年6～9月，我们应用更昔洛韦治疗小儿病毒性脑炎83例．效果满意。现报告如下。     

更昔洛韦治疗巨细胞病毒性肝炎12例观察

婴儿巨细胞病毒(Cytomegatovirus，CMV)性肝炎，为新生儿CMV性肝炎的延续，亦可为生后获得性感染所致，起病缓慢而隐匿。临床上以阻塞性黄疸，肝脾肿大，肝功能受损为特征。近2年来我们应用更昔洛韦治疗CMV性肝炎12例，疗效满意。现报告如下。     

更昔洛韦与阿昔洛韦治疗水痘临床疗效分析

目的观察更昔洛韦与阿昔洛韦治疗水痘的临床疗效。方法将115例水痘患者随机分为更昔洛韦治疗组和阿昔洛韦治疗组,治疗7d,观察疗效。结果更昔洛韦治疗组显效率为65．57％,有效率为31．15％,总有效率为96．72％;阿昔洛韦治疗组显效率为46．30％,有效率为33．33％,总有效率为79．63％。经秩和检验,Uc=2．553〉1．96,P〈0．05,差异有统计学意义。结论更昔洛韦治疗水痘临床疗效优于阿昔洛韦。     

更昔洛韦治疗婴幼儿巨细胞病毒肝炎疗效观察

巨细胞病毒 ( CMV)感染在我国相当普遍 ,较大儿童和成人感染 CMV后无症状 ,而婴幼儿则常表现为肝炎 ,严重者易出现肝功能衰竭或继发感染 ,从而危及生命。目前 CMV肝炎无特效治疗方法 ,2 0 0 1年 1月至 2 0 0 2年 1 2月 ,我院采用更昔洛韦 ( GCV)治疗婴幼儿 CMV肝炎 ,取得较好疗效。现报告如下。1　资料与方法1 .1　临床资料　本文 2 9例患儿 ,均符合 CMV肝炎诊断标准[1] 。其中男 1 8例 ,女 1 1例 ;年龄 34天至 5个月 ,平均 2 .8个月。临床表现为肝大 2 4例 ,脾大 1 8例 ,黄疸 2 9例 ,出现腹水 2例 ;肝功能检查示 GPT( 99.7± 42 .…     

更昔洛韦治疗婴幼儿CMV性肺炎18例

急性呼吸道感染是儿科常见的疾病。 70年代以腺病毒为主 ,80年代渐为呼吸道合胞病毒感染 (CMV) ,近年来 ,CMV感染受到重视 ,免疫力低下及免疫损害的婴幼儿易受其侵害 ,若不及时使用有效的抗巨细胞病毒药物治疗 ,则影响婴儿健康 ,严重者危及生命。更昔洛韦是抗 CMV的有效药物 ,现将观察更昔洛韦治疗婴儿 CMV性肺炎的疗效报告如下 :临床资料1.研究对象18例确诊为 CMV感染的婴幼儿为我院 2 0 0 1年 10月～2 0 0 2年 5月的住院患儿 ,其中男 12例 ,女 6例 ,30天～ 6个月 9例 ,1～ 2岁 4例 ,3～ 5岁 5例。2 .临床表现及辅助检查临床主要表现…     

更昔洛韦治疗婴儿巨细胞病毒肝炎26例疗效观察

20 0 0年 2月至 2 0 0 2年 7月 ,我院采用更昔洛韦治疗婴儿巨细胞病毒 ( CMV)肝炎 2 6例 ,总结如下。1　资料与方法1 .1　临床资料　 46例 CMV肝炎患儿中 ,男 2 7例 ,女1 9例 ;年龄 32天至 6个月 ;病程 7天至 5个月 ,平均 2个月。患儿均有黄疸 ,肝脏肿大 46例 ,脾脏肿大 2 5例 ,出生低体重 3例 ,早产儿 2例 ,小头畸形 2例 ,合并肺炎3例 ,皮肤瘀点、瘀斑 6例 ,脑积水 3例。实验室检查 :患儿血清总胆红素均升高 ,并肝功能异常 ;晨尿CMV- DNA( + ) ,血清 CMV- Ig M( + ) ;乙肝五项及丙肝抗体均阴性 ,并排除代谢性肝病、药物和中毒性肝炎…     

更昔洛韦静脉输液治疗婴幼儿肝炎的护理

我科在2000年3月-2001年12月间用更昔洛韦治疗了39名巨细胞病毒感染引起的婴幼儿肝炎患儿,达到了降低患儿的转氨酶,减轻症状,改善肝功能的目的。现将其护理体会总结如下: 1 临床资料 39例肝炎病均为住院患儿,男性,年龄为2～6个月,其中属垂直传播的22例,血标本结果示抗CMV-IgM(+),ALT 50～928U/L,AST 45～1 366U/L。经过更昔洛韦治疗     

Prophylaxis of cytomegalovirus infection with ganciclovir in allogeneic marrow transplantation.

Cytomegalovirus (CMV) infection is one of the most common causes of morbidity and mortality after allogeneic marrow transplantation. We studied 14 consecutive CMV-seropositive patients adding ganciclovir (2.5 mg/kg i.v. every 8 hours for 7 days prior to transplant and 6 mg/kg three times a week after neutrophils became greater than 0.5 x 10(9)/l and the patients were platelet transfusion-independent until d 70) to our previous prophylaxis regimen which consisted of intravenous immunoglobulin and acyclovir. The result was compared with 30 consecutive patients whom we studied with our previous regimen. The addition of ganciclovir did not cause any extra toxicities. The incidence of interstitial pneumonitis and cumulative probability of CMV excretion in the first 100 d post-transplantation was significantly reduced (p = 0.038 and p = 0.035 respectively). The result shows that addition of ganciclovir significantly decreased the incidence of CMV infection in the early post-transplantation period.     

Use of cytomegalovirus immune globulin and ganciclovir for the prevention of cytomegalovirus disease in lung transplantation

Cytomegalovirus (CMV) infection and disease continue to be significant causes of morbidity and mortality in lung transplant recipients. The potential benefits of CMV prophylaxis extend beyond prevention of the immediate CMV infection to potentially preventing CMV-associated complications, including superinfection due to Aspergillus bacteria, and other opportunistic infections, and bronchiolitis obliterans syndrome (BOS). Longer courses of prophylactic intravenous (IV) ganciclovir, sequential IV/oral therapy, addition of intravenous CMV immune globulin (CMV-IGIV), surveillance tests, and investigation of the role of hypogammaglobulinemia are a few of the strategies and issues being evaluated to improve CMV prophylaxis and, consequently, graft and patient survival.     

Late cytomegalovirus infection after oral ganciclovir prophylaxis in renal transplant recipients

The purpose of this study was to retrospectively review our experience with a consecutive group of 41 renal transplant recipients (R) who received a kidney from a cytomegalovirus (CMV) seropositive donor (D(+)) and had 3 months of prophylaxis with oral ganciclovir. Patients were prospectively monitored clinically and with determinations of CMV antigenemia for at least 6 months. Patients were followed for a mean period of 247+/-16 days. CMV antigenemia developed in 51% of patients (53% D(+)R(-), 47% D(+)R(+)) after the transplant, but in no case was antigenemia seen during the period of oral ganciclovir therapy. Antigenemia developed at a median of 167 days post transplant (range 99-522 days) and peak antigen counts ranged from <1-3940, and tended to be higher in D(+)R(-) recipients. Infection was symptomatic in 67% of the antigenemic patients and symptoms tended to be more marked in the D(+)/R(-) than in the D(+)/R(+) group. All symptomatic patients were treated with intravenous ganciclovir (21 days) followed by 9 weeks of oral ganciclovir and responded with resolution of symptoms and antigenemia. No evidence of tissue-invasive disease was seen. Recurrence of antigenemia was observed exclusively in the D(+)R(-) group, occurred with less severe manifestations of CMV infection, and invariably responded to retreatment with ganciclovir. Our results suggest that oral ganciclovir prophylaxis is effective in preventing CMV infection during the 3-month period of prophylaxis, that a 3-month period of prophylaxis appears to be sufficient for D(+)R(+) recipients, but a longer period of oral ganciclovir prophylaxis may be needed in D(+)R(-) recipients. Clinicians caring for renal transplant recipients should be vigilant to the possibility of late CMV infection, especially in D(+)R(-) recipients.     

Successful use of oral ganciclovir for the treatment of intrauterine cytomegalovirus infection in a renal allograft recipient

Congenital cytomegalovirus (CMV) infection occurs in approximately 1% of newborns and is the leading infectious cause of congenital birth defects. Female renal allograft recipients who develop CMV infection during pregnancy are at risk for both graft dysfunction and fetal morbidity. DNA-based analysis of amniotic fluid (AF) from at-risk pregnancies has been suggested as an adjunct/substitute for traditional culture. We have shown that CMV-polymerase chain reaction of AF is a useful diagnostic test for congenital CMV infection. Using this test we diagnosed CMV infection in the fetus of a 30-year-old renal transplant recipient. As termination was not an option for the family, the patient was extensively counseled and treated with oral ganciclovir. This resulted in clearance of the virus from the AF and the delivery of a healthy newborn girl, free of CMV disease. This is the first reported case to our knowledge of successful use of maternal ganciclovir to treat intrauterine CMV infection in a pregnant renal transplant recipient.     

Prevention of primary cytomegalovirus disease in organ transplant recipients with oral ganciclovir or oral acyclovir prophylaxis

Background: Optimal prophylaxis against cytomegalovirus (CMV) disease for organ transplant patients at risk for primary infection (donor seropositive, recipient seronegative, D+R?) remains to be determined. We hypothesized that prolonged oral ganciclovir therapy following intravenous therapy would provide increased protection. Methods: A total of 155 evaluable D+R? organ transplant recipients from 13 transplant centers were entered into the study: all received intravenous ganciclovir (5 mg/kg/day) for 5–10 days and then either oral acyclovir (400 mg tid) or oral ganciclovir (1 g tid) for an additional 12 weeks. Patients were assigned to their treatment groups at a central randomization site, with a separate randomization scheme for each of the organs transplanted (kidney, heart, or liver). In the case of kidney transplants, the patients were stratified according to source of the kidney (living related vs. cadaveric donor). The primary endpoint was the incidence of CMV disease in the first six months post‐transplant. Results: Treatment with oral ganciclovir was associated with a significant decrease in the incidence of symptomatic disease or viremia when compared with the oral acyclovir group (32% vs. 50%, P<0.05). This difference was most marked in terms of tissue invasive disease: only 3 of 15 symptomatic patients in the ganciclovir group vs. 10 of 21 in the acyclovir group developed tissue‐invasive infection (P<0.05). There was a significant difference in the time to CMV disease or viremia in the two groups: mean time 212±17 days post‐transplant for the acyclovir group vs. 291±13 days for the ganciclovir group (P<0.001). The incidence of allograft rejection was 34% in the ganciclovir group and 46% in the acyclovir group (P=NS). Leukopenia was more common in the ganciclovir group (P<0.05), but in no case did it require drug discontinuation. Ganciclovir resistance did not develop in this study. Conclusion: Prophylaxis with oral ganciclovir following a brief course of intravenous ganciclovir provides useful protection against primary CMV disease.     

Comparison of higher dose and lower dose ganciclovir for cytomegalovirus prophylaxis in seropositive heart transplant recipients

S.-O. Lee, J.H. Rim, H. Sung, S.-H. Kim, S.-H. Choi, C.W. Lee, T.J. Yun, J.-W. Lee, J.H. Woo, Y.S. Kim, J.-J. Kim. Comparison of higher dose and lower dose ganciclovir for cytomegalovirus prophylaxis in seropositive heart transplant recipients.
Transpl Infect Dis 2010: 12: 31–37. All rights reserved
Background. We performed a retrospective historical cohort study to compare the efficacy of higher dose (HD, 10 mg/kg/day for 2 weeks, followed by 5 mg/kg/day intravenously for 2 weeks) and lower dose (LD, 5 mg/kg/day for 4 weeks) ganciclovir (GCV) for cytomegalovirus (CMV) prophylaxis in seropositive heart transplant recipients.
Methods. All consecutive patients undergoing heart transplantation (HT) between June 1999 and January 2008 at our institution were enrolled. All recipients were seropositive for CMV before HT. Before October 2005, 72 patients received the HD regimen and after October 2005, 36 patients received the LD regimen. We followed up all patients for 1 year.
Results. In the HD group 43 of 72 patients (60%) developed CMV infections vs. 21 of 36 patients (58%) in the LD group ( P =0.89). CMV diseases occurred in 4 patients of the HD group (6%) and 4 patients of the LD group (11%) ( P =0.44). The incidence of acute rejection was not significantly different between the 2 groups (14% vs. 6%; P =0.33). Among patients who completed 4-week courses of prophylaxis, 32 of 58 patients (55%) in the HD group developed CMV infections vs. 18 of 30 patients (60%) in the LD group ( P =0.66). CMV diseases occurred in 3 patients of the HD group (5%) and 4 of the LD group (13%) ( P =0.22). Acute rejection incidence did not differ significantly between the 2 groups (17% vs. 7%; P =0.21).
Conclusions. LD GCV for CMV prophylaxis may not be inferior to the HD regimen in seropositive HT recipients.     

更昔洛韦联合思密达治疗轮状病毒肠炎56例效果分析

将收治的轮状病毒肠炎婴幼儿120例随机分为2组,对照组64例,使用更昔洛韦5～10mg/(kg·d)静脉滴注;观察组56例,更昔洛韦5～10 mg/(kg·d)静脉滴注,同时口服思密达,每次1/3包,3次/d。治疗后,对照组和观察组总有效率分别为62.50%(40/64)和89.29%(50/56),差异有统计学意义(P<0.05)。表明更昔洛韦联合思密达治疗婴幼儿轮状病毒肠炎疗效显著,值得推广。     

Alterations in intrahepatic expression of duck hepatitis B viral markers with ganciclovir chemotherapy

Ducks congenitally infected with duck hepatitis B virus (DHBV) were treated with the guanosine analogue, ganciclovir, and the effect on serum and intrahepatic expression of DHBV DNA and viral proteins was examined. After 21 days of ganciclovir treatment, a substantial reduction in viraemia occurred; in contrast, the level of circulating DHBV surface antigen was unchanged. Ganciclovir therapy also substantially reduced the level of DHBV DNA replicative intermediates and the expression of viral core and surface antigen in hepatocytes. However, despite the antiviral treatment some liver cells, including the bile duct epithelial cells and putative oval cells, maintained their intense staining for the viral proteins. Furthermore, DHBV-infected cells in extrahepatic sites such as the pancreas, kidney and spleen were also unaffected by ganciclovir treatment. These results suggest that monotherapy with nucleoside analogues is unlikely to eliminate chronic hepadnaviral infection, and antiviral programs should be designed to target all cell populations infected by the virus.