Takahashi K, Yagisawa T, Hiroshi T, Teraoka S, Fuchinoue S, Honda H, Goya N, Tanabe K, Ebihara K, Ooba S
Nihon Hinyokika Gakkai Zasshi. 1989 Feb;80(2):175-84. doi: 10.5980/jpnjurol1989.80.175.
Cyclosporin (CYA) is now recognized as an effective immunosuppressant to lead to a marked improvement in graft survival in organ transplant recipients. Although the incidence of infection in the CYA group has been decreased compared with that in the azathioprine group, infectious diseases in 400 kidney transplant recipients treated with CYA were noted in our single center. Treatment strategy for infectious diseases: Antibiotics and/or gamma-Globulin were administered to all recipients with bacterial infections. Aciclovir was added in recipients with herpes simplex virus (HSV) infection or varicella zoster virus (VZV) infection. Human interferon-beta (HuIFN-beta) was used in recipients who had life-threatening viral infection, especially cytomegalovirus (CMV) pneumonitis. Glycyrrhizin was used for acute hemorrhagic cystitis and nephropathy due to adenovirus (AV). Trimethoprim sulfamethoxazole and/or pentamidine were added in recipients complicated with Pneumocystis carinii (Pc) pneumonitis or in order to prevent Pc pneumonitis. Infectious diseases: One hundred and six recipients had infectious diseases 129 times in this series, seventy-six percent of all infections occurred during the first 4 months after the transplantation. Urinary tract infection (UTI), herpes zoster and pulmonary infection were the most common infectious diseases, occurring in 28.7%, 24.0% and 23.2%, respectively. Septicemia or bacteremia developed in 9 recipients, secondary to UTI in 8 and to surgical wound infection in one. Sixty-one symptomatic viral infections occurred in 57 recipients. A total of 5 recipients (1.3%) died of interstitial pneumonitis. Infectious organisms: Viral and bacterial infections were most common, occurring in 47.3% and 41.9%, respectively. Viral species detected in these recipients with the frequency were HSV 14 times, CMV 9 times, VZV 31 times and AV 7 times. 1) The incidence of viral infections in kidney transplant recipients treated with CYA is relatively high compared to bacterial infections. 2) HuIFN-beta therapy is effective in the treatment of serious opportunistic herpes virus infections, especially CMV pneumonitis. 3) Glycyrrhizin therapy is effective in the treatment of acute hemorrhagic cystitis and nephropathy due to AV and hepatic dysfunction. 4) Aerosolised pentamidine therapy is very useful for prophylaxis of Pc pneumonitis.
环孢素（CYA）如今被公认为一种有效的免疫抑制剂，可显著提高器官移植受者的移植物存活率。尽管与硫唑嘌呤组相比，CYA组的感染发生率有所降低，但在我们的单中心研究中，仍观察到400例接受CYA治疗的肾移植受者出现了感染性疾病。感染性疾病的治疗策略：对所有细菌感染的受者给予抗生素和/或γ-球蛋白治疗。对单纯疱疹病毒（HSV）感染或水痘带状疱疹病毒（VZV）感染的受者加用阿昔洛韦。对患有危及生命的病毒感染，尤其是巨细胞病毒（CMV）肺炎的受者使用人干扰素-β（HuIFN-β）。甘草酸用于治疗腺病毒（AV）引起的急性出血性膀胱炎和肾病。对合并卡氏肺孢子虫（Pc）肺炎的受者或为预防Pc肺炎而加用甲氧苄啶磺胺甲恶唑和/或喷他脒。感染性疾病：在本系列研究中，106例受者发生了129次感染性疾病，所有感染的76%发生在移植后的前4个月。尿路感染（UTI）、带状疱疹和肺部感染是最常见的感染性疾病，发生率分别为28.7%、24.0%和23.2%。9例受者发生败血症或菌血症，其中8例继发于UTI，1例继发于手术伤口感染。57例受者发生了61次有症状的病毒感染。共有5例受者（1.3%）死于间质性肺炎。感染病原体：病毒和细菌感染最为常见，发生率分别为47.3%和41.9%。在这些受者中检测到的病毒种类及出现频率为：HSV 14次、CMV 9次、VZV 31次和AV 7次。1）与细菌感染相比，接受CYA治疗的肾移植受者中病毒感染的发生率相对较高。2）HuIFN-β治疗对严重的机会性疱疹病毒感染，尤其是CMV肺炎有效。3）甘草酸治疗对AV引起的急性出血性膀胱炎和肾病以及肝功能障碍有效。4）雾化喷他脒治疗对预防Pc肺炎非常有用。
