CAJ | 학술논문

目的探讨荧光定量PCR动态监测在预防肾移植术后人巨细胞病毒(HCMV)肺炎中的临床应用价值.方法同种异体肾移植患者242例.男144例,女98例,平均年龄42(17～71)岁.随机分为2组:实验组127例,对照组115例.实验组患者移植术后采用荧光定量PCR方法动态检测患者血、尿标本HCMV-DNA,其中任何一项HCMV-DNA拷贝数>1×103拷贝/ml者,连续静脉滴注更昔洛韦4周,按照肌酐清除率计算剂量(肾功能正常者剂量为5 mg/kg 2次/d;肾功能减退者,肌酐清除率50～69 ml/min时2.5 mg/kg,2次/d;肌酐清除率25～49 ml/min时2.5 mg/kg,2次/d;肌酐清除率10～24 ml/min时1.25 mg/kg,1次/d;肌酐清除率<10 ml/min时每周3次每次1.25 mg/kg,于血液透析后给予).对照组不进行定期检测及更昔洛韦预防用药,比较2组患者HC-MV肺炎发病、治疗情况及移植肾1年存活率. 结果实验组术后HCMV肺炎发生率6.3%(8/127);肺炎发生中位时间84(46～167)d;住院治疗中位时间36(30～57)d;病死率12.5%(1/8);呼吸机使用率12.5%(1/8),合并其他病原体感染率25.0%(2/8);移植肾1年存活率98.4%(125/127),其中1例为移植肾带功能死亡,1例为移植肾急性排斥失功.对照组术后HCMV肺炎发生率14.8%(17/115);肺炎发生中位时间51(34～138)d;住院中位时间40(21～67)d;病死率23.5%(4/17);呼吸机使用率29.4%(5/17),合并其他病原体感染率41.2%(7/17);移植肾1年存活率93.0%(107/115),死亡4例中3例为移植肾带功能,1例移植肾功能未恢复;4例为移植肾急性排斥失功.2组间比较住院治疗时间差异无统计学意义(P>0.05),其余各项(HCMV肺炎发生率、发生时间、病死率、呼吸机使用率、合并其他病原体感染率、移植肾1年存活率)差异均有统计学意义(P<0.05).结论荧光定量PCR动态监测肾移植术后患者血、尿标本HCMV-DNA载量,预防术后HCMV肺炎效果好,移植肾1年存活率提高.
목적 탐토형광정량PCR동태감측재예방신이식술후인거세포병독(HCMV)폐염중적림상응용개치.방법 동충이체신이식환자242례.남144례,녀98례,평균년령42(17～71)세.수궤분위2조:실험조127례,대조조115례.실험조환자이식술후채용형광정량PCR방법동태검측환자혈、뇨표본HCMV-DNA,기중임하일항HCMV-DNA고패수>1×103고패/ml자,련속정맥적주경석락위4주,안조기항청제솔계산제량(신공능정상자제량위5 mg/kg 2차/d;신공능감퇴자,기항청제솔50～69 ml/min시2.5 mg/kg,2차/d;기항청제솔25～49 ml/min시2.5 mg/kg,2차/d;기항청제솔10～24 ml/min시1.25 mg/kg,1차/d;기항청제솔<10 ml/min시매주3차매차1.25 mg/kg,우혈액투석후급여).대조조불진행정기검측급경석락위예방용약,비교2조환자HC-MV폐염발병、치료정황급이식신1년존활솔. 결과실험조술후HCMV폐염발생솔6.3%(8/127);폐염발생중위시간84(46～167)d;주원치료중위시간36(30～57)d;병사솔12.5%(1/8);호흡궤사용솔12.5%(1/8),합병기타병원체감염솔25.0%(2/8);이식신1년존활솔98.4%(125/127),기중1례위이식신대공능사망,1례위이식신급성배척실공.대조조술후HCMV폐염발생솔14.8%(17/115);폐염발생중위시간51(34～138)d;주원중위시간40(21～67)d;병사솔23.5%(4/17);호흡궤사용솔29.4%(5/17),합병기타병원체감염솔41.2%(7/17);이식신1년존활솔93.0%(107/115),사망4례중3례위이식신대공능,1례이식신공능미회복;4례위이식신급성배척실공.2조간비교주원치료시간차이무통계학의의(P>0.05),기여각항(HCMV폐염발생솔、발생시간、병사솔、호흡궤사용솔、합병기타병원체감염솔、이식신1년존활솔)차이균유통계학의의(P<0.05).결론 형광정량PCR동태감측신이식술후환자혈、뇨표본HCMV-DNA재량,예방술후HCMV폐염효과호,이식신1년존활솔제고.
Objective To discuss the clinical value of dynamic monitoring the copies of human cytomegalovirus(HCMV)-DNA in prophylaxis of HCMV pneumonia after renal transplantation.Methods There were 242 cadaveric renal transplantation recipients including 144 males and 98 females,with the average age of 41(from 17 to 71).They were divided into 2 groups(experimental group 127 cases,control group 115 cases).Recipients in experimental group were routinely monitored by blood preparation and urine aliquot FQ-PCR.The therapy was initiated when HCMC-DNA>1×103 copies/ml by blood preparation and/or urine aliquot FQ-PCR with intravenous ganciclovir for 4 weeks.The dosage was calculated according to creatinine clearance rate.FQ-PCR monitoring and Preemptive therapy was not performed in the control group.The pneumonia rate, death rate and survival between the two groups were compared. Results In experimental group, the HCMV pneumonia incidence rate was 6.3 % (8/127), onset time was 46-167 d, median time was 84 d, hospitalization time was 30-57 d,median time was 36 d, death rate was 12.5 % (1/8), breathing machine using rate was 12.5 % (1/8),concurrent other pathogen infection rate was 25 % (2/8), and + year renal graft survival rate was 98.4% (125/127).One was dead with graft function and the other dysfunction was because of acute rejection.In control group, the HCMV pneumonia incidence rate was 14.8%(17/115), onset time was 34-138 d,median time was 51 d, hospitalization time was 21-67 d,median time was 40 d,breathing machine using rate was 29.4% (5/17),concurrent other pathogen infection rate was 41.2%(7/17), death rate was 23.5% (4/17), and 1 year renal graft survival rate was 93.0% (107/115).Three was dead with graft function and the other one was dead of DGF.The other 4 cases of renal dysfunction were because of acute rejection.Significant difference existed between the 2 groups (P<0.05) except for hospitalization time (P> 0.05). Conclusion The preemptive therapy of CMV pneumonia after renal transplantation by dynamic monitoring the copies of HCMV-DNA in recipients could have a good effect, and the 1 year renal graft survival rate could be higher.