肝移植术后巨细胞病毒再感染的预防与治疗

目的　探讨肝移植术后巨细胞病毒(CMV)再感染的预防、诊断及治疗。方法　回顾性分析44例原位肝移植患者的临床资料。结果　44 例中,术前43 例(97.7 %)有CMV潜伏性感染,其中6例(14.0 %)术后发生CMV再感染。6例CMV再感染患者的CMV pp65抗原均为阳性,3例CMV IgM阳性,均为无临床症状的CMV活动性感染,其中5例治愈,无一例发展为CMV病,1 例因上消化道大出血死亡。43例中,仅有7例CMV再感染高危病例接受了抗CMV感染的预防性治疗,患者在生存期内未发生CMV再感染。结论　在我国,肝移植患者术前CMV潜伏性感染的发生率较高,测定CMV pp65抗原可以早期诊断CMV再感染;对CMV再感染的高危患者进行预防性治疗可以降低术后CMV再感染的发生率;对无临床症状的CMV再感染者进行及时、规范的治疗是防止CMV病发生的关键。

Prevention and treatment of cyomegalovirus reinfection after liver transplantation

Objective To analyze the diagnosis, prevention and treatment of cytomegalovirus (CMV) reinfection after liver transplantation.Methods The clinical data of 44 patients receiving orthotopic liver transplantation (OLT) were retrospectively analyzed.Results Of the 44 patients, there were 43 ( 97.7 % ) with incubative CMV infection before OLT. Asymptomatic CMV reinfection occurred\} in 6 patients ( 14.0 % ). All patients with CMV infection were positive for CMV-pp65 and 3 positive for CMV-IgG. Five patients recovered and one patient died from massive gastrointerstinal hemorrhage. No patient progressed to CMV disease. Seven patients with high risk of CMV reinfection received prophylactic treatment and had no CMV reinfection.Conclusion The incidence of incubative CMV infection before OLT is high in recipients of our country. CMV-pp65 antigenemia assay is effective in the early diagnosis of CMV reinfection after OLT. It is effective to decrease the rate of CMV reinfection by target prophylactic antiviral therapy in high risk recipients. Preemptive strategy for asymptomatic CMV reinfection is the key to prevent it from developing CMV disease.