Schulman L L, Reison D S, Austin J H, Rose E A
Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY 10032.
Arch Intern Med. 1991 Jun;151(6):1118-24.
To evaluate the incidence and clinical features of cytomegalovirus (CMV) pneumonitis after cardiac transplantation, we identified 27 (16%) of 171 consecutive recipients in whom CMV pneumonitis was confirmed by strict diagnostic criteria. Cytomegalovirus pneumonitis occurred in 6 (30%) of 20 patients treated with azathioprine and prednisone, and 8 (25%) of 32 patients treated with azathioprine, cyclosporine, and prednisone, but only 13 (11%) of 119 patients treated with cyclosporine and prednisone. The incidence of CMV pneumonitis was not related to recipient preoperative CMV titers or to postoperative cardiac rejection, but there was a trend toward increased CMV pneumonitis in patients who received organs from CMV-positive donors. Mean onset of CMV pneumonitis was 2.9 +/- 1.6 (SD) months after transplantation. In the azathioprine-prednisone group, CMV was always associated with at least one other respiratory pathogen (Aspergillus, n = 5; Pneumocystis carinii, n = 2). In the two cyclosporine groups, CMV was either the sole respiratory pathogen (n = 9), or associated with P carinii (n = 11). Roentgenographically, diffuse bilateral hazy pulmonary opacities were present in 19 (70%) of 27 patients, but focal subsegmental opacity (26%), small pleural effusion (26%), and lobar consolidation (7%) were also observed. When bronchoscopy was performed, bronchoalveolar lavage was the most sensitive technique for detecting CMV (72%), whereas transbronchial biopsy (39%) and combined washings and brushings (33%) were relatively insensitive techniques. Respiratory failure and death occurred in 52% and 44%, respectively, of patients with CMV pneumonitis. In this population of immunocompromised hosts: (1) CMV pneumonitis, alone or with other respiratory pathogens, was a major cause of morbidity and mortality; (2) localized roentgenographic opacity did not exclude CMV pneumonitis; (3) bronchoalveolar lavage was the most sensitive bronchoscopic technique for detecting CMV pneumonitis.
为评估心脏移植术后巨细胞病毒（CMV）肺炎的发病率及临床特征，我们在171例连续接受心脏移植的患者中，依据严格诊断标准确诊了27例（16%）CMV肺炎患者。在接受硫唑嘌呤和泼尼松治疗的20例患者中，有6例（30%）发生CMV肺炎；在接受硫唑嘌呤、环孢素和泼尼松治疗的32例患者中，有8例（25%）发生CMV肺炎；而在接受环孢素和泼尼松治疗的119例患者中，仅有13例（11%）发生CMV肺炎。CMV肺炎的发病率与受体术前CMV滴度或术后心脏排斥反应无关，但接受来自CMV阳性供体器官的患者中，CMV肺炎有增加趋势。CMV肺炎的平均发病时间为移植后2.9±1.6（标准差）个月。在硫唑嘌呤-泼尼松组，CMV感染总是与至少一种其他呼吸道病原体相关（曲霉菌，5例；卡氏肺孢子虫，2例）。在两个环孢素组中，CMV要么是唯一的呼吸道病原体（9例），要么与卡氏肺孢子虫相关（11例）。X线表现上，27例患者中有19例（70%）出现双侧弥漫性模糊肺浸润影，但也观察到局灶性亚段性浸润影（26%）、少量胸腔积液（26%）和肺叶实变（7%）。进行支气管镜检查时，支气管肺泡灌洗是检测CMV最敏感的技术（72%），而经支气管活检（39%）和联合冲洗及刷检（33%）相对不敏感。CMV肺炎患者分别有52%和44%发生呼吸衰竭和死亡。在这群免疫功能低下的宿主中：（1）CMV肺炎单独或与其他呼吸道病原体共同感染，是发病和死亡的主要原因；（2）X线局限性浸润影不能排除CMV肺炎；（3）支气管肺泡灌洗是检测CMV肺炎最敏感的支气管镜技术。
