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目的观察肾脏疾病免疫抑制剂治疗后继发巨细胞病毒(cMV)肺炎的临床特征、治疗和转归。方法在1999年6月至2006年12月在中山大学附属第一医院接受免疫抑制剂治疗的肾脏疾病患者中,采用免疫细胞化学法对外周血和(或)支气管肺泡灌洗液白细胞进行CMV抗原检测,同时结合临床表现,将21例诊断为CMV肺炎,并给予丙氧鸟苷5～10 mg·kg~(-1)·d~(-1)静脉滴注,停用免疫抑制剂治疗。现回顾性分析其临床特征和预后。结果21例患者发生CMV肺炎前均使用了皮质激素,13例为甲基泼尼松冲击治疗,平均总剂量为(3.2±0.6)g,15例接受环磷酰胺治疗,平均总剂量为(3.8±1.3)g,免疫抑制剂使用到诊断CMV肺炎的时间中位数为25(13～92)d;21例患者均有发热、干咳、气促气喘,X线胸片均示间质性肺炎,19例伴低氧血症,11例支气管灌洗液白细胞CMV抗原阳性。9例患者存活,12例(57.2%)死亡。然而丙氧鸟苷平均疗程为(26.2±6.3)d。结论CMV肺炎是接受免疫抑制剂治疗的肾脏疾病患者的严重并发症,病死率高,然而丙氧鸟苷是其有效治疗药物。
Objective To observe the clinical characteristics, treatment and prognosis of cytomegalovirus (CMV) pneumonia after treatment of immunosuppressive agents for kidney disease. Methods Immunocytochemistry was used to detect CMV antigen in peripheral blood and / or bronchoalveolar lavage fluid leukocytes from June 1999 to December 2006 in the First Affiliated Hospital of Sun Yat-sen University. 21 cases were diagnosed as CMV pneumonia and given intravenous drip of 5 ~ 10 mg · kg ~ (-1) · d -1 of ganciclovir with immunosuppressant. The clinical features and prognosis are retrospectively analyzed. Results 21 patients were treated with corticosteroids before CMV pneumonia and 13 patients were treated with methylprednisone. The average total dose was (3.2 ± 0.6) g and 15 patients received cyclophosphamide. The average total dose was 3.8 ± 1.3) g. The median time to immunosuppressive agents for the diagnosis of CMV pneumonia was 25 (13-92) days. All 21 patients had fever, dry cough, shortness of breath and wheezing and asthma. All the patients had interstitial pneumonia , 19 cases with hypoxemia, 11 cases of bronchoalveolar lavage fluid CMV antigen positive. Nine patients survived and 12 (57.2%) died. However, the median course of treatment was (26.2 ± 6.3) days. Conclusions CMV pneumonia is a serious complication of renal disease in immunosuppressed patients with high mortality. However, ganciclovir is an effective treatment.