更昔洛韦治疗特发性血小板减少性紫癜应用指征

目的探讨更昔洛韦(GCV)治疗人巨细胞病毒(HCMV)感染相关的特发性血小板减少性紫癜的(ITP)应用指征。方法选择血清HCMV DNA PCR和(或)HCMV IgM检测呈阳性ITP患儿46例,采用逆转聚合酶扩增反应(RT-PCR)检测巨核系祖细胞中HCMV晚期抗原mRNA,并行GCV治疗,判定其疗效及应用指征。结果46例血清HCMV-DNA PCR阳性和(或)血清HCMV-IgM阳性的ITP骨髓巨核祖细胞HCMV晚期抗原基因mRNA阳性19例,GCV治疗有效16例,mRNA阴性27例,GCV治疗有效4例。阳性组疗效高于阴性组,有显著性差异(P<0.01)。结论HCMV感染的ITP患儿,若对常规治疗无效,应检测其巨核祖细胞内HCMV晚期抗原基因mRNA,阳性者是应用更昔洛韦的有效指征。     

Effect of individualized therapy for AIDS patients with cytomegalovirus retinitis in intravitreal ganciclovir injections

The effect of intravitreal ganciclovir injection combined with intravenous infusion on acquired immune deficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR) was investigated. A total of 32 eyes in 23 AIDS patients diagnosed as CMVR from 2017 to 2018 were included in the retrospective study. All patients underwent induction therapy by using intravenous drip of the anti-cytomegalovirus (CMV) agent ganciclovir (5 mg/kg q12h) combined with intravitreal ganciclovir injection (3 mg/time, 2 times/wk). The visual acuity, fundus photographs, lesion location, and number of intravitreal injections were observed preoperatively and postoperatively. Totally 14 eyes were cured during induction therapy. The number of injections [4.13 (2 to 6)] in CMVR patients with peripherally fundus lesions were significantly lower than those with central lesions [4.89 (2 to 6)]. The individualized therapy of intravitreal ganciclovir injections for AIDS patients with CMVR can effectively reduce the numbers of intravitreal injections.     

Clinical Evaluation of Intravitreal Injection of Ganciclovir in Refractory Corneal Endotheliitis

ABSTRACT

Purpose: To evaluate the efficacy and safety of intravitreal ganciclovir (GCV) injection in refractory endotheliitis.

Methods: Retrospectively recruited 25 eyes with endotheliitis, proved by clinical manifestations, positive PCR for viral DNA and responded poor to topical and systemic antiviral medications. All patients received additional continued intravitreal GCV injections.

Results: Cytomegalovirus (CMV), varicella zoster virus (VZV), and herpes simplex virus (HSV) DNA were detected in 64.0%, 28.0%, and 8.0% of the eyes, respectively. Within 2 weeks after the last injection, 16/25 eyes recovered corneal clarity; active keratic precipitates (KPs) were eliminated in 21/25 eyes; intraocular pressure (IOP) was controlled in 12/15 eyes with elevated IOP on study entry. Best-corrected visual acuity increased at the last follow-up (p = 0.016). Clinical recurrence occurred in three patients. No complications were detected.

Conclusions: CMV endotheliitis was the main type of refractory endotheliitis. Despite its invasive nature, intravitreal GCV injection appears to be an effective method for refractory endotheliitis.     

更昔洛韦眼用凝胶和阿昔洛韦滴眼液治疗病毒性角膜炎疗效对比

目的：探讨病毒性角膜炎应用更昔洛韦眼用凝胶的疗效。

方法：随机选择2013-05/2014-10我院收治的84例101眼病毒性角膜炎患者作为研究对象,随机分为更昔洛韦组和对照组,分别给予更昔洛韦眼用凝胶和阿昔洛韦滴眼液治疗,2wk后观察疗效。

结果：两组患者治疗后较治疗前病毒性角膜炎各症状(畏光、流泪、疼痛、异物感)及各体征(睫状充血、角膜上皮缺损、角膜基质水肿、角膜荧光素染色)评分均有显著改善,更昔洛韦组改善更为明显(P<0.05); 更昔洛韦组有效率(92.9%)明显高于对照组(59.5%),差异有统计学意义(P<0.05); 两组患者不良反应无统计学差异(P>0.05),更昔洛韦组复发率明显低于对照组(P<0.05)。

结论：更昔洛韦眼用凝胶是一种安全有效的抗病毒滴眼液,治疗病毒性角膜炎疗效确切,值得临床中推广应用。     

Prevention dof recurrent cytomegalovirus disease in renal and liver transplant recipients: effect of oral ganciclovir

Background: Although the primary treatment of symptomatic cytomegalovirus (CMV) disease in organ transplant recipients is successful in >90% of individuals, relapsing disease, particularly in those with primary infection, remains an important problem. Previously, we had observed that the rate of symptomatic recurrence was >60% in those with primary disease (seronegative for CMV prior to transplant), and approximately 20% in those who were seropositive prior to transplant. The present study was undertaken to determine whether a maintenance regimen of oral ganciclovir for 2–3 months added to the routine 14–21 days of intravenous ganciclovir would further prevent symptomatic CMV recurrence. Methods: From May 1995 until June 1998, all kidney and liver transplant recipients with confirmed tissue‐invasive CMV disease or CMV syndrome were treated with 14–21 days of intravenous ganciclovir (5 mg/kg b.i.d. with dose adjusted for renal dysfunction) followed by 2–3 months of oral ganciclovir (2 g daily). The incidence of recurrence of CMV disease and/or viremia during and after oral therapy was then determined over a mean follow‐up of 530.6 days. Results: Thirty‐seven patients, 19 kidney and 18 liver transplant recipients, were studied; 5 had biopsy‐proven tissue‐invasive disease (13.5) and 32 suffered a CMV syndrome (86.5). Twenty‐one of these patients (58.6) were seronegative for CMV prior to transplant and received an allograft from a seropositive donor (D+/R?). Overall, 10 patients (27.0) developed CMV recurrence. Eight of 21 patients who were D+/R? for CMV (38.1) developed recurrence as opposed to 2 of 16 patients with other serologic status (12.5) (P=0.14). Patients with recurrent CMV disease and/or viremia had a peak antigenemia assay titer during their initial CMV event of 319.2 positive cells/2 slides compared with 109.8 positive cells/2 slides for patients without recurrent CMV infection (P=0.14); the trend of having a higher peak antigenemia assay titer among patients who recurred occurred both in patients who were at risk of primary CMV infection (D+/R? for CMV) and in those who were not. Two patients developed recurrent infection with strains of CMV that were resistant to ganciclovir. Conclusions: This new therapeutic regimen of oral ganciclovir following intravenous ganciclovir slightly reduced the overall rate of recurrent CMV disease and/or viremia, but it still did not adequately prevent CMV recurrence in patients who are at risk of primary infection prior to transplant. Of particular concern, 2 patients with primary infection treated with this regimen developed ganciclovir‐resistant recurrent disease ( Note Presented in part at the American Society of Transplant Physicians Meeting, May 1999, Chicago, Illinois.
).     

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。     

在EBV阳性鼻咽癌细胞内SAHA联合GCV细胞毒作用的时间点分析

目的探讨伏立诺他（SAHA）联合GCV对EBV阳性鼻咽癌细胞的细胞毒作用有效时间点,为临床化疗提供依据。方法。利用Real-timePCR检测SAHA作用下EBV阳性鼻咽癌细胞C666TK的表达情况;通过MTI＂检测SAHA联合GCV的细胞毒性。结果SA—HA作用16h时TK的表达最多,并且MTr结果显示SAHA作用16h后联合GCV两者的细胞毒作用最强。结论SAHA作用16h后联合GCV抗鼻咽癌效果较好。