肾移植术后巨细胞病毒肺炎伴急性呼吸窘迫综合征的治疗

[目的]探讨肾移植术后巨细胞病毒肺炎伴急性呼吸窘迫综合征的治疗方法。[方法]1992年至2001年我院肾移植术后巨细胞病毒肺炎合并急性呼吸窘迫综合征患者42例,全部给予呼吸机辅助呼吸、氧疗,以及抗病毒治疗,丙氧鸟苷10 mg/(kg·d),分2次静滴,7~10 d无好转加用或改用磷钾酸钠180 mg/(kg·d),分3次静滴;调整免疫抑制剂:泼尼松减量至10 mg/d,环孢素剂量减至发病前的1/3~1/4,或停用环孢素,全部停用霉酚酸酯或硫唑嘌呤,直至体温正常、症状消失;其中12例患者在此治疗基础上,给予胸腺肽(日达先)治疗,1.6 mg皮下注射,每天或隔天1次至体温正常。[结果]42例患者总存活率38％(16/42),给予胸腺肽治疗的患者存活83％(10/12),明显高于没有接受胸腺肽治疗的患者的20％(6/30)(P<0.01)。所有存活病人肾功能正常,仅1例于1个内发生急性排斥。[结论]为提高肾移植术后巨细胞病毒肺炎合并急性呼吸窘迫综合征的疗效,应给予抗病毒治疗、调整免疫抑制剂、呼吸机辅助呼吸等综合治疗;免疫增强剂胸腺肽可能提高存活率,不增加急性排斥反应的发生。

Experiences on the Treatment of Patients with Acute Respiratory Distress Syndrome Caused by Cytomegalovirus Pneumonia After Renal Transplantation

[Objective] To study the treatment of patients with acute respiratory distress syndrome (ARDS) caused by cytomegalovirus (CMV) pneumonia after renal transplantation. [Methods] 42 patients with ARDS caused by CMV pneumonia after renal transplantation in our hospital from 1992 to 2001, were managed with breathing machines and oxygen therapy. All cases were treated with intravenous infusion of Gancyclovir 10 mg/(kg .d). If gancyclovir showed no effect after treatment for 7 ~ 10 d, intravenous infusion of Fos Carnet was added with the dosage of 180 mg/(kg.d). The dosage of prednisone was adjusted to 10 mg/d, and azathioprine or MMF was withdrawn in all patients, and the dosage of cyclosporin was adjusted to 1/3-1/4 of the baseline or withdrawn until the temperature re-tuned to normal and symptoms disappeared. Among 42 cases, 12 were administrated with zadaxin (1.6 mg, subcutaneous injection, everyday or alternatively). [Results]Among 42 patients, the survival rate was 38% (16/42) . The survival rate in the cases treated with or without zadaxin was 83% (10/12) and 20. 0% (6/30) respectively, and there was significantly difference between them ( P < 0. 01). A-mong all survival cases, there was only 1 patient that developed acute rejection. [Conclusion] Administration with anti-viral drugs, adjustment of immunosuppressive agents, and management with breathing machines are important for the treatment of patients with ARDS caused by CMV pneumonia after renal transplantation. It suggests that immunopotentiator zadaxin may improve the survival rate, and not increase the risk of acute rejection.