Erice A, Jordan M C, Chace B A, Fletcher C, Chinnock B J, Balfour H H
JAMA. 1987 Jun 12;257(22):3082-7.
Thirty-one immunocompromised patients with severe cytomegalovirus (CMV) disease were treated with intravenous ganciclovir. Twenty-one patients had received transplants--15 bone marrow recipients, five renal allograft recipients, and one liver transplant recipient--while the other ten were immunocompromised due to acquired immunodeficiency syndrome (six), hematologic malignancies (three), and systemic lupus erythematosus (one). They presented with one or more of the following syndromes: CMV pneumonitis (19), CMV of the gastrointestinal tract (six), CMV retinitis (seven), and CMV hepatitis (three). Seventeen (55%) of 31 patients demonstrated clinical improvement during ganciclovir therapy, with the best response seen in the transplant recipients. Viremia ceased in 14 (93.3%) of 15 patients after a mean of 4.7 days of therapy; viruria ceased in eight (53.3%) of 15 patients after a mean of 11 days of therapy. Ganciclovir plasma concentrations at a dosage of 2.5 mg/kg/three times a day were as follows: mean peak, 16.04 mumol/L; mean trough, 2.38 mumol/L. Neutropenia occurred in 11 (35%) of 31 patients and in nine (60%) of 15 bone marrow transplant recipients. We conclude that ganciclovir exerted an antiviral effect against CMV and may play a role in the treatment of CMV disease in patients with depressed immunity, especially bone marrow and organ transplant recipients.
31例患有严重巨细胞病毒（CMV）疾病的免疫功能低下患者接受了静脉注射更昔洛韦治疗。21例患者接受了移植——15例骨髓移植受者、5例肾移植受者和1例肝移植受者——而另外10例因获得性免疫缺陷综合征（6例）、血液系统恶性肿瘤（3例）和系统性红斑狼疮（1例）导致免疫功能低下。他们表现出以下一种或多种综合征：CMV肺炎（19例）、胃肠道CMV感染（6例）、CMV视网膜炎（7例）和CMV肝炎（3例）。31例患者中有17例（55%）在更昔洛韦治疗期间出现临床改善，移植受者的反应最佳。治疗平均4.7天后，15例患者中有14例（93.3%）病毒血症停止；治疗平均11天后，15例患者中有8例（53.3%）病毒尿停止。每天2.5mg/kg三次剂量的更昔洛韦血浆浓度如下：平均峰值，16.04μmol/L；平均谷值，2.38μmol/L。31例患者中有11例（35%）出现中性粒细胞减少，15例骨髓移植受者中有9例（60%）出现中性粒细胞减少。我们得出结论，更昔洛韦对CMV具有抗病毒作用，可能在免疫功能低下患者，尤其是骨髓和器官移植受者的CMV疾病治疗中发挥作用。
