van den Berg A P, Klompmaker I J, Haagsma E B, Peeters P M, Meerman L, Verwer R, The T H, Slooff M J
Department of Clinical Immunology, University Hospital, Groningen, The Netherlands.
Clin Transplant. 1996 Apr;10(2):224-31.
It has been reported that cytomegalovirus (CMV) infections increase the susceptibility of transplant patients for other opportunistic infections. Most of these studies date back from a time when CMV infection was difficult to diagnose and antiviral treatment not available. We therefore analyzed CMV-related morbidity after OLT in 111 consecutive patients. CMV monitoring was done weekly using the antigenemia assay, a quantitative marker of the viral load, in addition to serology. CMV infection occurred in 66/95 (69%) evaluable patients. Antigenemia was detected in 94% of them. The number of CMV antigen-positive cells was helpful to monitor the course of infection and differentiate CMV disease from other complications. CMV infection was symptomatic in 48/66 (73%) patients. Mild disease occurred in 30 patients, and severe constitutional symptoms or organ involvement in 18. No patient died as a direct result of CMV infection, but mortality between day 30 and 180 tended to be higher in CMV-infected patients (15 vs. 0%, p < 0.1). CMV infection was associated with a 2.45-fold higher incidence of major infections between day 30 and 180 after OLT (p < 0.05). Most of these infections were caused by gram-positive cocci. We conclude that CMV not only causes substantial morbidity, but also increases the risk of bacterial infections.
据报道，巨细胞病毒（CMV）感染会增加移植患者发生其他机会性感染的易感性。这些研究大多可追溯到CMV感染难以诊断且尚无抗病毒治疗的时期。因此，我们分析了111例连续接受肝移植（OLT）患者的CMV相关发病率。除血清学检测外，每周还使用抗原血症检测法（一种病毒载量的定量指标）进行CMV监测。95例可评估患者中有66例（69%）发生了CMV感染。其中94%检测到抗原血症。CMV抗原阳性细胞数量有助于监测感染进程，并将CMV疾病与其他并发症区分开来。66例患者中有48例（73%）的CMV感染出现症状。30例患者发生轻度疾病，18例出现严重的全身症状或器官受累。没有患者因CMV感染直接死亡，但CMV感染患者在第30天至180天之间的死亡率有升高趋势（15%对0%，p<0.1）。CMV感染与OLT后第30天至180天之间主要感染的发生率高出2.45倍相关（p<0.05）。这些感染大多由革兰氏阳性球菌引起。我们得出结论，CMV不仅会导致严重的发病率，还会增加细菌感染的风险。
