【摘要】 目的 研究肾移植受者术前巨细胞病毒(CMV)感染对术后急性排斥的影响及预 防性抗病毒治疗的意义。方法 回顾性分析416例肾移植受者的术前巨细胞病毒感染,预防性 抗病毒治疗和急性排斥的发生情况,并用Logistic回归分析各因素对急性排斥的影响。术前感 染受者根据有无预防性抗病毒治疗分为治疗组和非治疗组,比较两组间急性排斥发生率。结 果 术前巨细胞病毒感染组的急性排斥率显著高于非感染组(29.9%比19.5％,P=0.014),术前 感染受者发生急性排斥的风险增高将近1倍。预防性抗病毒治疗能降低术后CMV疾病的发生 率但对急性排斥无影响。结论 术前巨细胞病毒感染是术后急性排斥独立的危险因子。常规的 预防性抗病毒治疗并不能减少由感染介导的免疫损伤而导致的急性排斥的发生。更多还原

【Abstract】 Objective To investigate the effect of pretransplant cytomegalovirus infection on acute rejection and assess the value of common prophylactic antivirus therapy. Methods Retrospective single center study of 416 transplant recipients from October 2000 to September 2003 was made. The impact of pretransplant cytomegalovirus infection and other factors (age, panel reactive antibodies, induction therapy, cold ischemia time, delayed graft function) on acute rejection was analyzed. In pretransplant CMV infected recipients, the incidence of acute rejection was compared between ganciclovir-treated and non-treated ones.Results Fifty-five recipients had acute rejection in pretransplant cytomegalovirus positive group,whose incidence was significantly higher than that in noninfected group(29.9% vs 19.5% ,P=0.014). Pretransplant infection was identified as an independent predictor of acute rejection. The adjusted odds ratio was 1.807. Between ganciclovir-treated and nontreated recipients of prelransplant positive CMV, there was no significant difference of acute rejection occurrence (P=0.650) .Conclusions Pretransplant cytomegalovirus positive recipients are at higher risk of acute rejection after transplantation. Pretransplant cytomegalovirus infection is an independent risk factor for acute rejection and common prophylactic antiviral therapy can not reduce the incidence of acute rejection caused by cytomegalovirus infection-mediated immunologic injuries.更多还原