肾移植患者应用咪唑立宾临床探究.docVIP

肾移植患者应用咪唑立宾临床探究 　　　　　　　作者：李晓北，尹航，胡小朋，王玮，张勇，马麟麟，王勇，张小东 【摘要】 目的：研究咪唑立宾(MZR)在肾移植患者中应用的临床特点。方法：2005年9月至2006年2月间共16例肾移植患者接受MZR治疗。5例患者为肾移植术后直接应用MZR，11例患者由于经济原因从霉酚酸酯（MMF）切换成MZR。全部患者均采用以钙调神经蛋白抑制剂为基础的三联免疫抑制方案。本组患者随访期间重点监测用药后血常规、移植肾功能、肝功能、尿酸、血糖、血脂等生化指标，同时记录患者出现的所有临床不良反应及治疗，包括：各种细菌、病毒感染，移植肾急性排斥反应等。综合评价该药物作为免疫抑制治疗方案的安全性、有效性。结果：在MZR治疗后3个月~15个月的随访期间，患者全部存活，且移植肾功能良好。急性排斥发生率为12.5%,未出现难治性排斥。消化道副反应发生少。患者主要不良反应是高尿酸血症和骨髓抑制,但通过MZR减量及对症处理后基本都可以控制，预后好。术后感染方面与其他药物相比差异无显著性。结论：MZR是一种安全有效的免疫抑制剂,具有疗效稳定，副反应程度轻的特点。在严密随访的情况下可取得良好的临床效果。 【关键词】 咪唑立宾；免疫抑制剂；肾移植 　　Clinical Study of Mizoribine in Renal Transplant Recipients 　　The Affiliated Beijing Chaoyang Hospital of Capital University of Medical Sciences,Beijing 100043, China Abstract: Objective To study the clinical efficacy and characteristics of Mizoribine (MZR) in renal transplant recipients. Methods Sixteen patients who were administered with MZR from September 2005 to Feburary 2006 were enrolled in this study. All the recipients were the first transplants and took the triple immunosuppressive protocol which based on calcineurin inhibitor agents. MZR was taken directly just after renal transplantation in 5 patients, while the conversion from MMF to MZR was done in other 11 patients due to economic reasons. The biochemical items and clinical symptoms were monitored and recorded. The clinical data of these recipients was analyzed retrospectively. Results During the follow up period, all 16 patients were alive in good conditions. They had stable and almost normal renal grafts function, including 2 patients recovered from acute rejection episode after antirejection therapies. The adverse events in gastrointestinal tract were rare. The main adverse reactions were hyperuricemia and myelosuppression. However, lowering the dosage of MZR as well as symptomatic treatments could ameliorate such kinds of adverse events. The incidence of involved posttransplant infection was similar with that related to other immunosuppressants. Conclusion MZR is a safe a