肝移植术后巨细胞病毒感染的防治研究

目的探讨肝移植患者术后巨细胞病毒 (CMV)感染情况及其与急性排斥反应的关系。方法应用PCR和ELISA方法检测 78例肝移植受体手术前后、78例供体及 70例接受上腹部手术的非肿瘤患者血清中的CMV DNA和CMV抗体 ,用免疫组织化学方法检测肝组织中CMV抗原。结果供、受体术中肝脏活体组织学检查的CMV早期抗原 (EA)和晚期抗原 (LA)全部为阴性。术前CMV DNA或CMV IgM阳性的受体术后均为阳性 ;术前CMV DNA或CMV IgM阴性的受体术后CMV DNA或CMV IgM转为阳性的分别有 2 6 %和 10 %。 78例受体CMV DNA阳性率由术前的 5 %增加到术后的 31% ,两者比较差异有显著意义 (P <0 0 5 )。 2 6例患者发生了 33次急性排斥反应 ,16次 (49% )CMV DNA检测阳性、11次 (33% )CMV IgM检测阳性 ,而在术后常规检测血CMV DNA和CMV IgM的阳性率分别不超过 13%和 9% ,两者比较差异有显著意义 (P <0 0 5 )。 2 6例发生急性排斥患者肝脏活体组织学检查CMV EA和CMV LA阳性者均为 9例 (2 7% ) ,与术后的常规肝脏穿刺结果比较差异有显著意义 (P <0 0 5 )。结论 1.肝移植术后CMV感染率明显升高。 2 .CMV感染可能是发生急性排斥反应的危险因素。 3.发生急性排斥反应时 ,应使用抗CMV药物 ;未感染CMV的受体接受感染供体的肝脏时应预防用药。

Cytomegalovirus infection after liver transplantation

Objective To study the relationship between cytomegalovirus (CMV) infection and acute rejection in liver transplantation patients. Methods PCR and ELISA assay were used to detect CMV-DNA and CMV antibody in serum of 78 recepients pre- and post- operation,78 donors and 70 patients who underwent upper-abdominal operation for non-cancer disease. Immunohistochemistry (IHC) was used to detect CMV antigen in liver biopsy. Results Of all the patients early and late antigen (EA and LA) were not detected by liver biopsy during transplantation. CMV-DNA and CMV-IgM were still positive after liver transplantation in recepients with preoperative positive results. CMV-DNA and CMV-IgM turned to positive in 26% and 10% respectively in preoperatively negative recipients. Postoperatively CMV-DNA positive rate increased from 5% to 31% ( P < 0.05).Thirty-three episodes of acute rejection occurred in 26 cases,and in 16 episodes (49%) CMV DNA was positive and CMV-IgM was positive in 11(33%) ( P <0.05),compared with positive rate of 13% and 9% in all recipients in postoperative peripheral blood. In 9 out of 26 cases (27%) suffering from acute rejection the early and late antigen were positive in liver biopsy,the difference was significant compared with postoperative routine liver biopsy ( P <0.05). Conclusion 1. The CMV infection rate increased significantly after liver transplatation. 2.CMV infection may be a risk factor of acute rejection.3.Anti-cytomegalovirus drug is mandatory for the treatment of acute rejection;preemptive use of anti-cytomegalovirus drug is suggested for the uninfected recipients receiving grafts from donors infected with CMV.