不同预防方案对肝移植受者术后巨细胞病毒感染率的影响

摘要

Objective:To investigate the status of postoperative cytomegalovirus (CMV) infection among the liver transplant recipients and to evaluate the effects of prophylactic solutions on CMV infection after liver transplantation in China.Methods:All the clinical and follow-up data was retrospectively investigated in 309 liver transplantation patients from January 2004 to March 2007 in Liver Transplantation Center,Zhongshan Hospital,Fudan university.Results:In the preoperative CMV-seropositive recipients,the CMV infection rates in the three prophylactic groups (PG group) who have been treated with intravenous ganciclovir (GCV),acyclovir (ACV),GCV + ACV were 10.5 ％,15.9％ and 7.9 ％,respectively.The incidences of the CMV disease were 10.5％,8.3％ and 3.2％,which showed significant differences compared to those in the non-prophylactic group (NPG group,42.3％ and 15.4％,P＜0.01).One-year overall survival rates of the three PG groups were 86.8％,78.0％ and 88.9％,respectively.There was statistical difference in one-year survival rate between GCV+ ACV group and the NPG group (P＜0.05).Conclusions:In the preoperative CMV-seropositive recipients,all the three different prophylactic methods [GCV 2.5 mg/(kg · d) ; ACV (0.2 g); and GCV 2.5 mg/(kg · d) + ACV 0.2 mg/(kg · d),3 times perday] can lower the incidence of CMV infection and CMV disease.Moreover,GCV + ACV prophylactic treatment can significantly increase one-year survival rate of liver transplantation patients.%目的:了解肝移植受者术后巨细胞病毒(cytomegalovirus,CMV)感染情况,探讨预防方案对肝移植受者术后CMV感染的预防作用.方法:回顾分析复旦大学附属中山医院肝移植中心2004年1月-2007年3月309例肝移植患者术后1年内的临床资料.结果:术前受体CMV-IgG阳性的肝移植患者中,3个预防组(PG组)分别采用更昔洛韦(ganciclovir,GCV)、阿昔洛韦(acyclovir,ACV)和GCV+ ACV预防后,CMV隐性感染发生率分别为10.5％、15.9％和7.9％；CMV病发生率分别为10.5％、8.3％和3.2％,与未预防组(NPG组)的42.3％和15.4％相比有显著差异(P＜0.01).3个PG组患者的1年总生存率分别为86.8％、78.0％和88.9％,其中GCV+ ACV组和NPG组的差异有统计学意义(P＜0.05).结论:静滴GCV[2.5mg/(kg·d)]、口服ACV(0.2 g,3次/d)、静滴GCV[2.5 mg/(kg·d)]后序贯口服ACV(0.2g,3次/d)3种方式预防用药均可明显降低术前受体CMV-IgG阳性肝移植患者术后CMV感染发生率和病死率；GCV+ ACV可明显提高肝移植受者术后的1年生存率.