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-  2015 

免疫健全者重症肺炎后巨细胞病毒感染两例并文献复习

DOI: doi:10.7507/1671-6205.2015113

Keywords: 免疫健全宿主, 重症肺炎, 巨细胞病毒感染

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Abstract:

目的总结免疫健全者重症肺炎后活动性巨细胞病毒感染的临床特征和诊治要点。 方法报告2例于我院呼吸重症监护病房诊治的基础免疫健全宿主重症肺炎后巨细胞病毒活动性感染病例, 并结合文献资料对该病的危险因素、临床特征和诊治要点进行分析。 结果2例患者均为老年患者, 因"重症肺炎、Ⅰ型呼吸衰竭"入住我科, 经有创机械通气、广谱抗生素抗感染、激素抗炎及支持治疗后体温正常, 氧合改善, 肺部渗出影吸收好转, 成功脱机拔管。之后患者氧合进一步改善不明显, 且肺部渗出影进展, 外周血巨细胞病毒DNA转阳, 加用更昔洛韦抗病毒治疗后氧合改善, 肺部渗出影吸收。结合文献资料, 在基础免疫健全者, 重症肺炎后出现活动性巨细胞病毒感染的危险因素包括有创机械通气、糖皮质激素应用; 临床特征为氧合恶化、肺部渗出影增多, 而普通细菌、真菌培养无阳性发现; 诊断试验包括外周血巨细胞病毒定量核酸扩增试验、巨细胞病毒pp65抗原检测和组织病理学检查; 治疗方法推荐缬更昔洛韦片口服或更昔洛韦静脉滴注, 疗程至少2周。 结论巨细胞病毒活动性感染在基础免疫功能正常的危重症患者中频发, 对于原发疾病为重症肺炎、接受有创机械通气及应用糖皮质激素的患者, 需警惕巨细胞病毒肺炎的发生, 及早诊断并给予相应的治疗, 可改善该类患者的预后

References

[1]  1. Stanberry LR, Rosenthal SL, Mills L, et al. Longitudinal risk of herpes simplex virus (HSV) type 1, HSV type 2, and cytomegalovirus infections among young adolescent girls. Clin Infect Dis, 2004, 39:1433-1438.
[2]  3. Kalil AC, Florescu DF. Prevalence and mortality associated with cytomegalovirus infection in nonimmunosuppressed patients in the intensive care unit. Crit Care Med, 2009, 37:2350-2358.
[3]  7. Ziemann M, Sedemund-Adib B, Reiland P, et al. Increased mortality in long-term intensive care patients with active cytomegalovirus infection. Crit Care Med, 2008, 36:3145-3150.
[4]  8. Kotton CN, Kumar D, Caliendo AM, et al. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation, 2013, 96:333-360.
[5]  11. Ong DS, Klein Klouwenberg PM, VerduynLunel FM, et al. Cytomegalovirus seroprevalence as a risk factor for poor outcome in acute respiratory distress syndrome. Crit Care Med, 2015, 43:394-400.
[6]  2. Gandhi MK, Khanna R. Human cytomegalovirus:clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis, 2004, 4:725-738.
[7]  4. Jain M, Duggal S, Chugh TD. Cytomegalovirus infection in non-immunosuppressed critically ill patients. J Infect Dev Ctries, 2011, 5:571-579.
[8]  5. Limaye AP, Kirby KA, Rubenfeld GD, et al. Cytomegalovirus reactivation in critically-ill immunocompetent patients. JAMA, 2008, 300:413-422.
[9]  6. Osawa R, Singh N. Cytomegalovirus infection in critically ill patients:a systematic review. Critical Care, 2009, 13:R68.
[10]  9. Papazian L, Fraisse A, Garbe L, et al. Cytomegalovirus. An unexpected cause of ventilator-associated pneumonia. Anesthesiology, 1996, 84:280-287.
[11]  10. Chiche L, Forel JM, Roch A, et al. Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients. Crit Care Med, 2009, 37:1850-1857.
[12]  12. Balthesen M, Messerle M, Reddehase MJ. Lungs are a major organ site of cytomegalovirus latency and recurrence. J Virol, 1993, 67:5360-5366.
[13]  13. Chen K, Kolls JK. T cell-mediated host immune defenses in the lung. Annu Rev Immunol, 2013, 31:605-633.

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