社團法人臺灣臨床藥學會

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【綜合評述】器官移植病人巨細胞病毒感染之預防與治療
Prophylaxis and Treatment for Cytomegalovirus Infection in Solid Organ Transplant Recipients
巨細胞病毒,器官移植,CMV 感染,抗病毒藥物預防,先發性治療、Cytomegalovirus (CMV), Solid Organ Transplantation, CMV Infection, Antiviral Prophylaxis, Preemptive Therapy
劉媖媚Ying-Mei Liu1 、陳秀菊Hsiu-Chu Chen1,* 、施智源Zhi-Yuan Shi2 、吳明芬Ming-Fen Wu1 、劉文雄Wen-Shyong Liou1,3
1臺中榮民總醫院藥學部 、2臺中榮民總醫院感染科 、3中國醫藥大學藥學系
巨細胞病毒 (cytomegalovirus, CMV) 在器官移植是一個重要的致病病毒,它會增加病人的罹病率及死亡率。若未給與抗病毒藥物預防,CMV 感染與感染症最常發生於器官移植後的最初3 個月內。CMV 感染症之發生率及嚴重度會因免疫抑制劑的使用型態、捐贈者及受贈者的CMV 血清學狀態,以及不同型態的器官移植而異。術前血清學檢查CMV-immunoglobulin G (IgG) 陰性之受贈者接受了CMV-IgG 陽性捐贈者的器官 (D+/R-),發生CMV 感染症的風險最高。預防CMV 感染的目的是為了減少標的器官罹病及與其相關的死亡率,兩種主要預防策略是預防性給與抗病毒藥物(antiviral prophylaxis) 與先發性治療 (preemptive therapy)。靜脈注射 (intravenous, IV) ganciclovir 及口服valganciclovir 是預防及治療移植後CMV 感染的第一線用藥,而foscarnet 及cidofovir 因腎毒性較大,保留於治療具抗藥性或頑固型的CMV 感染時使用。
 
Cytomegalovirus (CMV) is an important viral pathogen after solid organ transplantation (SOT), which causes significant morbidity and mortality. CMV infection and disease occur most often during the first 3 months after SOT, if without antiviral prevention. The risk of CMV disease is highest in CMV-seronegative SOT recipient, who receives a latently infected organ from a CMV-seropositive donor (D+/R-). The incidence and severity of CMV infection and disease vary with types of immunosuppressive regimen, serology status of recipient and donor, and types of organ transplantation. The aim of CMV prevention strategy is to decrease end-organ disease and related mortality. Antiviral prophylaxis and preemptive therapy are the two major strategies. Intravenous ganciclovir and oral valganciclovir are used as the first-line medications for CMV prevention and therapy. Foscarnet and cidofovir are associated with significant nephrotoxicity, therefore they are reserved for the treatment of refractory and resistant CMV infection.
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