摘要
【目的】探讨肾移植受者使用麦考酚钠肠溶片三联免疫抑制治疗的有效性和安全性。【方法】选取2009年10月至2014年1月在本院接受尸体肾移植的受者60例,并随机分为麦考酚钠组（30例）和吗替麦考酚酯组（30例）,两组肾移植受者术后分别应用他克莫司＋麦考酚钠＋泼尼松三联免疫抑制方案（麦考酚钠组）和他克莫司＋吗替麦考酚酯＋泼尼松（吗替麦考酚酯组）三联免疫抑制方案,术后随访观察,应用统计学方法比较两组受者术后人/肾存活率,急性排斥反应发生率,移植肾功能恢复情况及药物不良反应（感染、腹泻、肝功异常、高血压、高血糖等）的发生情况。【结果】所有受者随访12~63个月,两组人/肾存活率均为100%。两组术后早期各有2例出现急性排斥反应,应用甲泼尼龙（methylprednisolone,MP）或MP＋抗人T淋巴细胞兔免疫球蛋白冲击后逆转,无移植物丢失。麦考酚钠组中出现移植肾功能恢复延迟2例,吗替麦考酚酯组中出现移植肾功能恢复延迟3例,均未调整免疫抑制方案,规律血液透析,每2~3 d透析1次,术后恢复泌尿时间为7~29 d,伴随尿量增加,肾功逐渐恢复。至随访终点,麦考酚钠组30例受者移植肾功能良好,血肌酐（serum creatinine,SCr）为（92.6±12.7）μmol/L,吗替麦考酚酯组中有1例出现移植肾功能不全,SCr 190μmol/L,发展为慢性移植肾肾病,其余29例受者移植肾功能良好,SCr为（90.6±13.5）μmol/L,上述差异均无明显统计学意义（P〉0.05）。两组药物不良反应观察结果显示,两组在肺部感染、肝功损害、高血压、高血糖发生率方面均无明显统计学差异,但麦考酚钠组的腹泻发生率较吗替麦考酚酯组明显降低[（1.5±0.8）次/d vs（3.5±1.6）次/d;P〈0.05]。【结论】麦考酚钠与他克莫司、泼尼松联合应用于肾移植受者,在提高人/肾存活率、抑制急性排斥反应发生、移植肾功能恢�
[Objective]To explore the efficacy and safety of the triple immunosuppressive therapy based on enteric-coated mycopheno- late sodium （EC-MPS）. [ Methods ] From Oct 2009 to Jan 2014, 60 recipients received cadaveric kidney transplantation in our hospital were selected and randomly divided into two groups： EC-MPS group （30 cases） and mycophenolate mofetil（MMF） group （30 cases）. Re- cipients in EC-MPS group were treated with EC-MPS, tacrolimus （FK-506） and prednisone （Pred）. Recipients in MMF group were treated with MMF, FK-506 and Pred. Recipient/graft survival rate and acute rejection incidence were compared between the two groups. The graft function and adverse drug reactions （such as infection, diarrhea, abnormal liver function, hypertension and hyperglycemia） were observed and statistically analyzed. [ Results ] All recipients were followed up for 12-63 months. The recipient/graft survival rates of the two groups were all 100%. However, there were two cases with acute rejection in each group. No graft loss occurred after the use of methylprednisolone （MP） or anti-human T lymphocyte rabbit immu- noglobulin（ATG）. Two cases with graft function recovery delay occurred in EC-MPS group and three cases in MMF group. For the five cases, immunosuppressive regimens were not changed. They gradually recovered their renal functions after receiving hemodialysis every 2- 3 days. After 7-29 days, postoperative emiction occurred, following urine output increase and renal function recovery. Till the end of follow- up, all 30 cases had good graft functions in EC-MPS group with the average serum creatinine （SCr） （92.6 ± 12.7） μmol/L. One case in MMF group developed into chronic allograft nephropathy with SCr 190 μmol/L and the other 29 cases had good graft function with the average SCr （90.6 ± 13.5） μmol/L. No statistically significant difference was observed between the two groups （P〉0.05）. As for adverse drug reac- tions, there was no statistically significant differen
出处
《武警后勤学院学报（医学版）》
CAS
2015年第6期434-437,共4页
Journal of Logistics University of PAP（Medical Sciences）
关键词
肾移植
麦考酚钠
吗替麦考酚酯
急性排斥反应
腹泻
Renal transplantation
Mycophenolate sodium
Mycophenolate mofetil
Acute rejection
Diarrhea
