更昔洛韦预防肾移植术后巨细胞病毒感染

目的:观察国产更昔洛韦预防肾移植术后巨细胞病毒(CMV)感染的效果,并与伐昔洛韦比较。方法:60例肾移植病人,男性38例,女性22例,年龄(38±s12)a,随机分为2组。均于术后d7～10抗病毒治疗,更昔洛韦组予更昔洛韦250mg加入100mL氯化钠注射液,iv,gtt,bid;伐昔洛韦组予伐昔洛韦300mg,po,bid,疗程均为2wk。观察术后6mo内的CMV感染情况,检测CMV血清学指标。结果:术后3mo的CMV抗原阳性率和抗CMVIgM抗体阳性率,更昔洛韦组均低于伐昔洛韦组(P<0.05),而抗CMVIgG抗体阳性率,2组间无显著差异(P>0.05)。发生CMV上呼吸道感染10例,更昔洛韦组2例(7%),伐昔洛韦组8例(27%),P<0.05;发生CMV肺炎4例,更昔洛韦组1例(3%),伐昔洛韦组3例(10%),P>0.05。呼吸系统感染发生率更昔洛韦组低于伐昔洛韦组(10%vs37%,P<0.05),且发生时间延迟。结论:术后静脉注射更昔洛韦较口服伐昔洛韦能更好地预防肾移植术后CMV感染的发生。

Ganciclovir preventing cytomegalovirus infection of post renal transplantation

AIM: To appreciate the role that antiviral ganciclovir play in prevention of post operation infection of cytomegalovirus (CMV) and compare with that of valaciclovir. METHODS: Sixty patients (M 38, F 22; age(38±s 12) a ) with renal transplantation were designed and included in the research. All patients with no infection of CMV were randomly divided into two groups. The ganciclovir group (30 patients) was administered with ganciclovir 250 mg+sodium chloride injection 100 mL, iv, gtt,bid. The valaciclovir group (30 patients) was received valaciclovir 300 mg, po. bid. The treatment periods both began on 7-10 d after renal transplantation for 2 wk. Serology of CMV and CMV antigenemia were examined before and 3,6 mo after renal transplantation. The pulmonary CMV infection was studied 6 mo after renal transplantation. RESULTS: Positive ratios of CMV antigenemia and anti-CMV IgM in the ganciclovir group were lower than those in the valaciclovir group (P< 0.05) 3, 6 mo after transplantation. Positive ratio of anti-CMV IgG in both groups showed no significant difference (P> 0.05). Total, there were 14 patients with CMV infection, including 10 patients with the upper respiratory tract infection and 4 with CMV pneumonia. Ratio of the CMV upper respiratory tract infection in ganciclovir group (2 patients, 7 %) was lower than that in valaciclovir group (8 patient, 27 %),P< 0.05. Ratio of the CMV pneumonia in ganciclovir group (1 patients, 3 %) was similar to that in valaciclovir group (3 patient, 10 %), P> 0.05. Total ratio of CMV infection in ganciclovir group was lower and later than that in valaciclovir group (10 % vs 37 %,P< 0.05). CONCLUSION: Intravenous injection of gancilcovir is superior to the oral intake of valaciclovir in preventing CMV infection after renal transplantati