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目的:探讨肝移植术后患者巨细胞病毒(cytomegalovirus,CMV)感染的诊治方法。方法:回顾性分析150例成人肝移植病例的临床资料。结果:移植术后即开始静脉使用更昔洛韦,连续2周以预防CMV感染。预防用药2周后检测外周血白细胞中CMV抗原,CMV抗原超过5/50000白细胞为CMV感染阳性,CMV抗原阳性21例(14.0%,21/150),其中20例(95.2%)表现为无症状CMV感染,1例表现为CMV肺炎。对12例CMV抗原超过5/50000白细胞但少于15/50000白细胞者予口服阿昔洛韦治疗,9例CMV抗原超过15/50000白细胞者予静脉使用更昔洛韦治疗。经治疗后患者的血清CMV抗原全部转阴,1例CMV肺炎死于呼吸衰竭。结论:外周血CMV抗原检测是诊断CMV感染的一项准确指标,可以指导防治CMV疾病用药,术后静脉使用更昔洛韦可以有效预防CMV感染的发生。
Objective: To investigate the diagnosis and treatment of cytomegalovirus (CMV) infection in patients after liver transplantation. Methods: A retrospective analysis of 150 cases of adult liver transplantation clinical data. RESULTS: Ganciclovir was administered intravenously immediately after transplantation for 2 weeks to prevent CMV infection. CMV antigens were detected in peripheral blood leukocytes 2 weeks after the prophylaxis treatment. The CMV antigens more than 5/50000 leucocytes were positive for CMV infection, and CMV antigen was positive in 21 cases (14.0%, 21/150), of which 20 cases (95.2%) showed asymptomatic CMV infection, 1 case showed CMV pneumonia. 12 cases of CMV antigen more than 5 / 50,000 white blood cells but less than 15 / 50,000 white blood cells were given acyclovir treatment, 9 cases of CMV antigen more than 15 / 50,000 white blood cells were treated with intravenous ganciclovir. After treatment, all patients with CMV antigen negative, 1 case of CMV pneumonia died of respiratory failure. Conclusion: The detection of CMV antigen in peripheral blood is an accurate indicator to diagnose CMV infection, which can guide the prevention and treatment of CMV disease. Intravenous ganciclovir can effectively prevent CMV infection after operation.