TREATMENT OF CYTOMEGALO-VIRUS PNEUMONIA WITH GANCICLOVIR AND INTRAVENOUS CYTOMEGALO-VIRUS IMMUNOGLOBULIN IN PATIENTS WITH BONE-MARROW TRANSPLANTS
TREATMENT OF CYTOMEGALO-VIRUS PNEUMONIA WITH GANCICLOVIR AND INTRAVENOUS CYTOMEGALO-VIRUS IMMUNOGLOBULIN IN PATIENTS WITH BONE-MARROW TRANSPLANTS
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DOI：
10.7326/0003-4819-109-10-783
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发表时间：
1988-11-15
影响因子：
39.2
通讯作者：
MEYERS, JD
中科院分区：
文献类型：
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作者：
REED, EC;BOWDEN, RA;MEYERS, JD
探讨更昔洛韦联合静脉注射巨细胞病毒免疫球蛋白治疗骨髓移植后巨细胞病毒肺炎是否有效。连续入组试验，治疗至少14天。对25例骨髓移植合并移植后巨细胞病毒性肺炎患者的连续样本进行开放性肺活检或支气管肺泡灌洗证实。肾功能异常或合并肺炎感染原因的患者，或诊断时依赖呼吸机的患者不符合条件。诱导治疗为更昔洛韦，每8小时2.5 mg/mg体重，连续14天；巨细胞病毒免疫球蛋白，第1、2、7天400 mg/kg，第14天200 mg/kg。根据肾功能调整更昔洛韦剂量。14天后症状改善但仍有症状的患者给予维持治疗，包括更昔洛韦（5mg /kg，每日1次，持续14天）和免疫球蛋白（200mg /kg，第21天）。临床恶化的患者继续接受诱导剂量。如果中性粒细胞计数低于500倍，则停止更昔洛韦治疗。106/L连续2天。每周进行3次肾、肝功能、血细胞计数和血液、咽喉和尿液的病毒培养。25例患者中有13例（52%）（95% CI, 31 ~ 72）在肺炎初始发作中存活。治疗96小时以上的23例患者中有17例（74%）停止了病毒排泄。停止治疗后3例确诊肺炎复发，2例可能复发。诱导治疗中出现中性粒细胞减少3例，维持治疗中出现中性粒细胞减少6例。更昔洛韦联合巨细胞病毒免疫球蛋白治疗的25例巨细胞病毒肺炎首发患者中有13例（52%）的生存率显著优于89例使用先前抗病毒治疗方案的13例（15%）的生存率。
To determine if the combination of ganciclovir and intravenous cytomegalovirus immunoglobulin is effective in patients with cytomegalovirus pneumonia after bone marrow transplant. Consecutive entry trial with treatment for a minimum of 14 days. Consecutive sample of 25 patients with bone marrow transplants and cytomegalovirus pneumonia after transplant proven by open lung biopsy or bronchoalveolar lavage. Patients with abnormal renal function or concomitant infectious causes of pneumonia, or who were respirator-dependent at diagnosis, were not eligible. Induction treatment consisted of ganciclovir, 2.5 mg/mg body weight every 8 hours for 14 days, and cytomegalovirus immunoglobulin, 400 mg/kg on days 1, 2, and 7 and 200 mg/kg on day 14. Ganciclovir dosage was adjusted for renal function. Patients who were improved but still symptomatic after 14 days were given maintenance treatment consisting of ganciclovir, 5 mg/kg once daily for an additional 14 days, and immunoglobulin, 200 mg/kg on day 21. Patients with clinical deterioration continued to receive induction doses. Ganciclovir therapy was discontinued if the neutrophil count fell below 500 .times. 106/L for 2 consecutive days. Serial tests of renal and liver function, blood counts, and viral cultures of blood, throat, and urine were obtained 3 times a week. Thirteen of twenty-five (52%) patients (95% CI, 31 to 72) survived the initial episode of pneumonia. Viral excretion ceased in 17 of 23 (74%) patients treated more than 96 hours. Proven recurrences of pneumonia occurred in 3 patients and possible recurrences in 2 after treatment was stopped. Three patients developed neutropenia during induction therapy and 6 patients during maintenance therapy. Survival of 13 (52%) of 25 patients from the initial episode of cytomegalovirus pneumonia with the regimen of ganciclovir and cytomegalovirus immunoglobulin is significantly better (P < 0.001) than the survival of 13 of 89 (15%) patients using previous antiviral regimens.