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肺移植受者巨细胞病毒感染的临床表现、诊断和治疗

Author
Martin Zamora, MD
Section Editors
Kieren A Marr, MD
Martin S Hirsch, MD
Deputy Editor
Anna R Thorner, MD
Translators
宋勇, 主任医师，教授

引言

巨细胞病毒(cytomegalovirus, CMV)是β疱疹病毒家族的一员，它仍是肺移植受者中发生并发症和死亡的重要原因[1]。它是肺移植受者中第二常见的感染，仅次于细菌性肺炎[2,3]。

尽管强效抗病毒药物的研发和可用已降低了CMV相关死亡率，但越来越多的证据表明CMV的间接影响可能与组织损伤和感染的病毒直接影响同样重要或甚至更加重要[3]。CMV诱导的免疫抑制可能引起其他机会致病菌的感染。此外，一些研究显示CMV感染和CMV病与急性和慢性排斥反应(闭塞性细支气管炎综合征)相关，但并非所有研究均显示如此[4-6]。

肺移植受者中CMV感染的诊断和治疗方法随着移植专家使用分子诊断技术和强效口服抗病毒药物缬更昔洛韦的经验的增加而不断发展。肺移植受者CMV感染的流行病学、临床特征、诊断和治疗将在此处讨论。肺移植受者中CMV感染的预防以及除CMV之外的其他病原体导致的感染并发症将在别处讨论。 (参见“肺移植受者巨细胞病毒感染的预防”和“肺移植术后的细菌感染”和“Nontuberculous mycobacterial infections in solid organ transplant candidates and recipients”和“实体器官移植候选者与受者的结核病”和“肺移植后真菌感染”)

流行病学

原发性CMV感染可通过涉及感染细胞或体液直接浸染的亲密身体接触而获得。原发性感染后，CMV感染将终生存在。人群研究显示在整个年轻成人期CMV血清阳性率逐渐增加。尽管差异很大，但在美国1/2以上的成人有既往感染的血清学证据。 (参见“免疫功能正常成人中巨细胞病毒感染的流行病学、临床表现和治疗”)

移植后CMV感染可以通过以下几种途径之一获得[3]：

                          

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Literature review current through: 2017-06 . | This topic last updated: 2017-07-11.
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