Pelaez Andres, Lyon G Marshall, Force Seth D, Ramirez Allan M, Neujahr David C, Foster Marianne, Naik Priyumvada M, Gal Anthony A, Mitchell Patrick O, Lawrence E Clinton
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
J Heart Lung Transplant. 2009 Jan;28(1):67-71. doi: 10.1016/j.healun.2008.10.008.
Respiratory syncytial virus (RSV) can cause severe lower respiratory tract infection (LRI) and is a risk factor for the development of bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx). Currently, the most widely used therapy for RSV is inhaled ribavirin. However, this therapy is costly and cumbersome. We investigated the utility of using oral ribavirin for the treatment of RSV infection after LTx.
RSV was identified in nasopharyngeal swabs (NPS) or bronchoalveolar lavage (BAL) using direct fluorescent antibody (DFA) in 5 symptomatic LTx patients diagnosed with LRI. Data were collected from December 2005 and August 2007 and included: age; gender; type of LTx; underlying disease; date of RSV; pulmonary function prior to, during and up to 565 days post-RSV infection; need for mechanical ventilation; concurrent infections; and radiographic features. Patients received oral ribavirin for 10 days with solumedrol (10 to 15 mg/kg/day intravenously) for 3 days, until repeat NPS were negative.
Five patients had their RSV-LRI diagnosis made at a median of 300 days post-LTx. Mean forced expiratory volume in 1 second (FEV(1)) fell 21% (p < 0.012) during infection. After treatment, FEV(1) returned to baseline and was maintained at follow-up of 565 days. There were no complications and no deaths with oral therapy. A 10-day course of oral ribavirin cost $700 compared with $14,000 for nebulized ribavirin at 6 g/day.
Treatment of RSV after LTx with oral ribavirin and corticosteroids is well tolerated, effective and less costly than inhaled ribavirin. Further studies are needed to directly compare the long-term efficacy of oral vs nebulized therapy for RSV.
呼吸道合胞病毒（RSV）可导致严重的下呼吸道感染（LRI），并且是肺移植（LTx）后闭塞性细支气管炎综合征（BOS）发生的一个危险因素。目前，治疗RSV最广泛使用的疗法是吸入利巴韦林。然而，这种疗法成本高且操作繁琐。我们研究了口服利巴韦林用于治疗LTx后RSV感染的效用。
在5例被诊断为LRI的有症状LTx患者中，使用直接荧光抗体（DFA）在鼻咽拭子（NPS）或支气管肺泡灌洗（BAL）中鉴定出RSV。数据收集自2005年12月至2007年8月，包括：年龄；性别；LTx类型；基础疾病；RSV日期；RSV感染前、感染期间及感染后565天内的肺功能；机械通气需求；合并感染；以及影像学特征。患者接受口服利巴韦林治疗10天，并联合甲泼尼龙（10至15mg/kg/天静脉注射）治疗3天，直至重复NPS检测为阴性。
5例患者在LTx后中位300天确诊为RSV-LRI。感染期间，平均第1秒用力呼气量（FEV(1)）下降了21%（p<0.012）。治疗后，FEV(1)恢复至基线水平，并在565天的随访中维持。口服治疗无并发症且无死亡病例。口服利巴韦林10天疗程的费用为700美元，而雾化吸入利巴韦林每天6g的费用为14000美元。
LTx后用口服利巴韦林和皮质类固醇治疗RSV耐受性良好、有效且比吸入利巴韦林成本更低。需要进一步研究直接比较口服与雾化治疗RSV的长期疗效。
