Hibberd P L, Tolkoff-Rubin N E, Cosimi A B, Schooley R T, Isaacson D, Doran M, Delvecchio A, Delmonico F L, Auchincloss H, Rubin R H
Transplantation Unit, Massachusetts General Hospital, Boston 02114.
Transplantation. 1992 Jan;53(1):68-72. doi: 10.1097/00007890-199201000-00013.
A prospective study to investigate risk factors for CMV disease was conducted in 94 renal transplant recipients. CMV disease was defined as either unexplained fever for greater than 3 days with viremia or unexplained fever for greater than 3 days with isolation of CMV from the urine or throat wash and at least one of the following: leukopenia, elevated serum alanine aminotransferase, or biopsy-proved invasive tissue infection of the lung or gastrointestinal tract. Fifty-three patients received immunosuppressive regimens consisting of prednisone and cyclosporine, with or without azathioprine. The remaining 41 patients were treated with these agents plus OKT3 (21 received OKT3 to treat rejection, 20 received OKT3 prophylactically). Thirty-seven patients were at minimal risk of CMV disease (donor and recipient seronegative for CMV); 12 patients were at risk of primary disease (donor seropositive, recipient seronegative), and 45 were at risk of reactivation disease (recipient seropositive at the time of transplantation). The incidences of CMV disease in the 3 groups were 0%, 58%, and 36%, respectively. Although the incidence of CMV disease in patients at risk of primary disease was not influenced by the immunosuppressive regimen, immunosuppression had a profound effect on the occurrence of CMV disease in CMV-seropositive transplant recipients. The incidence of CMV disease in those receiving OKT3 was 59%; but only 21% in those who did not receive OKT3. OKT3 increased the risk of CMV disease five-fold (odds ratio 5.2 (95% confidence limits 1.4-17.5)). In the CMV-seropositive patient, OKT3 was also the most important predictor of CMV disease by multivariate analysis (P less than 0.002). A pilot study of preemptive therapy with ganciclovir (2.5 mg/kg daily during OKT3 therapy) in 17 patients decreased the incidence of CMV disease without appreciable toxicity.
一项针对94例肾移植受者的前瞻性研究，旨在调查巨细胞病毒（CMV）疾病的危险因素。CMV疾病定义为：伴有病毒血症的不明原因发热超过3天；或从尿液或咽洗液中分离出CMV且不明原因发热超过3天，并伴有以下至少一项：白细胞减少、血清丙氨酸转氨酶升高，或经活检证实的肺部或胃肠道侵袭性组织感染。53例患者接受了由泼尼松和环孢素组成的免疫抑制方案，可加用或不加用硫唑嘌呤。其余41例患者在这些药物基础上加用OKT3（21例接受OKT3治疗排斥反应，20例接受OKT3预防性治疗）。37例患者发生CMV疾病的风险极低（供者和受者CMV血清学阴性）；12例患者有原发性疾病风险（供者血清学阳性，受者血清学阴性），45例有再激活疾病风险（移植时受者血清学阳性）。3组中CMV疾病的发生率分别为0%、58%和36%。虽然有原发性疾病风险患者的CMV疾病发生率不受免疫抑制方案影响，但免疫抑制对CMV血清学阳性移植受者CMV疾病的发生有深远影响。接受OKT3患者的CMV疾病发生率为59%；未接受OKT3患者的发生率仅为21%。OKT3使CMV疾病风险增加了五倍（优势比5.2（95%置信区间1.4 - 17.5））。在CMV血清学阳性患者中，多因素分析显示OKT3也是CMV疾病最重要的预测因素（P小于0.002）。一项对17例患者进行的更昔洛韦抢先治疗的初步研究（在OKT3治疗期间每日2.5 mg/kg）降低了CMV疾病的发生率，且无明显毒性。
