新的研究优化了器官移植后常见感染治疗措施
2012-08-24 17:41:06   来源： 丁香园   作者：  评论：0 点击：

1，Waiting to treat the commonest viral infections in transplant recipients until they reach a certain threshold is better than prophylactically treating all recipients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

1，一项即将在《美国肾脏病学会杂志(Journal of the American Society of Nephrology , JASN)》上发表的研究显示，在移植病人全身状况好转到某一程度之后再治疗移植中最常见的病毒感染，比移植前给予预防性的治疗效果要好。

2，Cytomegalovirus (CMV) infection is the most common infection in organ transplant recipients, who are susceptible to infections in general because they must take immunosuppressive medications long term. CMV infections can cause increased risks of other infections, organ rejection, heart complications, and diabetes.

2，巨细胞病毒（CMV）感染是器官移植病人中最常见的感染，由于移植病人需要长期服用免疫抑制药物，因此对各自病原都易感。巨细胞病毒感染可以导致其他感染的风险增加、器官排异、心脏并发症和糖尿病。

3，The two main strategies against CMV are called universal antiviral prophylaxis and pre-emptive therapy. In universal prophylaxis all patients at risk are given antiviral drugs (such as valganciclovir, valacyclovir, and ganciclovir) for several months after transplantation. In pre-emptive therapy, patients are intensively monitored for CMV activity by sensitive laboratory methods, and short-term antiviral treatment is given only to those with significant viral counts before symptoms occur.

3，对抗巨细胞病毒感染有两种主要的手段，广谱抗病毒药预防和先行治疗。广谱抗病毒药预防是指所有有感染 风险的移植病人在移植后都给予抗病毒药（例如缬更昔洛韦、伐昔洛韦和更昔洛韦）治疗数月。先行治疗是指通过敏感的实验室手段密切监测移植病人巨细胞病毒的 活动情况，对未出现临床症状但病毒计数显著升高的移植病人给予短程的抗病毒治疗。

4，To compare these strategies, Tomas Reischig, MD, PhD (Charles University Medical School and Teaching Hospital, in Pilsen, Czech Republic) and his colleagues assigned kidney transplant recipients—who either had CMV present in their blood or who received transplants from donors with CMV in their blood—to either three months of prophylaxis with valacyclovir or pre-emptive valganciclovir given when significant CMV counts were detected.

4，为比较这两种手段的效果，来自捷克共和国比尔森，查尔斯大学医学院教学医院的医学博士，哲学博士Tomas Reischig及其同事进行了一项研究。他们将血巨细胞病毒阳性或接受血巨细胞病毒阳性供体肾的肾移植病人，给予伐昔洛韦抗病毒治疗3月或在肾移植病人 巨细胞病毒计数明显升高时给予缬更昔洛韦先行治疗。

5，Among the major findings for 55 patients after three years:

CMV disease developed in 6% of patients in the pre-emptive therapy group and in 9% receivin prophylaxis

Patients in the prophylaxis group were 2.5 times more likely to develop moderate-to-severe kidney scaring and atrophy than patients receiving pre-emptive therapy.

Kidney biopsies showed that the prophylaxis group also had significantly higher expression of genes involved in kidney scaring.

5，3年后对纳入研究的55名移植病随访显示：

6%先行治疗组病人和9%抗病毒预防治疗组病人巨细胞病毒感染加重

抗病毒预防治疗组病人发展成中－重度肾瘢痕及肾萎缩的风险比先行治疗组高2.5倍

肾活检同样显示抗病毒预防治疗组与形成肾瘢痕的基因显著高表达

6，The occurrence of CMV was similar in both groups, but pre-emptive therapy improved 4-year survival of transplanted organs (92% vs 74%).

These findings indicate that compared with valacyclovir prophylaxis, pre-emptive valganciclovir therapy for CMV may lead to less severe kidney scaring and atrophy and to significantly better survival of transplanted organs.

6，巨细胞病毒感染的发生率在两组间相似，但先行治疗组移植后4年生存率提高（先行治疗组92%；抗病毒预防组74%）。

7，"In the view of short-term trial results, which favor CMV prophylaxis over pre-emptive strategy because of lower risk of acute rejection, we expected a translation of presumed benefit of prophylaxis to the long-term post-transplant period. In fact, we discovered that the opposite is true," said Dr. Reischig.

7，Reischig医生总结到，“从短期临床试验的结果来看，认为预防性抗巨细胞病毒治疗比先行治疗策略更好是因为急性排异反应的风险更低，我们曾经预期预防性抗病毒治疗策略在移植后的远期效果也优于先行治疗。而事实上，我们得出了相反的结论。”