咪唑立宾在白细胞减少同种肾脏移植患者中的替代免疫抑制治疗

A clinical study on mizoribine as an alternative immunosuppressant in kidney allograft recipients with leukopenia

目的 探讨咪唑立宾在同种肾脏移植术后白细胞减少患者中替代硫唑嘌呤或骁悉的治疗效果。方法 选取 32例白细胞减少 (WBC <4× 10 9·L-1)患者 ,将硫唑嘌呤或骁悉替换为咪唑立宾进行免疫抑制治疗。其中 5例白细胞 <3× 10 9·L-1的患者 ,初始时加用集落细胞刺激因子 75 μg(GCSF)一次或两次。 结果 所有患者均随访 3月以上。 2 7例未用GCSF的患者 ,1周后WBC计数均上升 ,与转换前比较差异有极显著意义 [(3.4± 0 .3)× 10 9·L-1vs.(3.9± 0 .3)× 10 9·L-1,t=10 .7,P <0 .0 1) ],转换 1月及 3月前后对照比较差异均有极显著意义。 2例患者在转换后发生排斥 ,激素冲击治疗后逆转。结论 咪唑立宾具有较少的骨髓抑制作用 ,可替代硫唑嘌呤或骁悉 ,安全、有效地应用于白细胞减少的肾脏移植患者。

Objective To investigate mizoribine as an alternative immunosuppressant to azathioprine (AZA) or mycophenolate mofetil (MMF) in kidney allograft recipients with leukopenia. Methods In 32 patients with leukopenia (WBC<4×10 9 ·L -1 ), AZA or MMF was converted to MZR, including 5 severe cases (WBC<3×10 9 ·L -1 ) initially treated with 1 or 2 pulses of 75 μg granulocyte colony-stimulating factor (GCSF). Results All the patients were followed up at least for 3 months. In those not administered with GCSF, WBC all increased with significant improvements at the end of week 1 \[(3.4 ±0.3)×10 9 ·L -1 vs. (3.9±0.3)×10 9 ·L -1 , t=10.7, P< 0.01 \], month 1 and month 3. Two acute rejection episodes occurred but were reverted by methylpredinisolone therapy. Conclusion With lower bone marrow suppression, mizoribine can be used as a safe and effective substitute for AZA or MMF in patients with leukopenia.