丙型肝炎患者肾移植术后霉酚酸酯的应用

Application of mycophenolate mofetil in hepatitis C patients after kidney transplantation

目的探讨丙型肝炎患者肾移植术后霉酚酸酯(MMF)的合理应用。方法随访49例丙型肝炎肾移植患者,术前肝功能正常,术后给予强的松(prednisonePred)、MMF、环孢素)或普乐可复三联免疫抑制治疗,将术后肝功能异常的患者分为持续服药(服药组)、减少或停用MMF(减停组)两组,均给予保肝治疗,观察各组治疗所需的天数。结果49例患者中19例患者出现肝功能异常,服药组8例、减停组11例,在相同治疗方案下,两组肝功能异常至好转及肝功能好转至正常所需的治疗天数均有显著差异(P<0.05)。结论丙型肝炎患者肾移植术后出现肝功能异常应减少或停用MMF,并及时给予保肝治疗,使患者肝功能尽快好转。

Objective To discuss adequate application of mycophenolate mofetil （MMF） in hepatitis C patients after kidney transplantation. Method A one-year follow-up study was conducted in 49 patients with hepatitis C but normal liver function before kidney transplantation, who were given postoperatively immunosuppressants of predisone, MMF and CsA/FK506. Patients with abnormal liver function after kidney transplantation who continued MMF therapy at routine dose and those with reduced or suspended MMF therapy all received intravenous therapy for liver protection, and the duration of therapies was recorded. Results Nineteen patients presented with abnormal liver function after operation, and the duration of abnormal liver function till recovery was 32.82±4.13 days in the patients with unsuspended MMF therapy and 13.31 ±2.98 days in those with reduced or suspended MMF （P〈0.05）; the former patients required subsequently 62.7±3.23 days to recover normal liver function and the latter need only 23.4±2.29 days （P〈0.05）. Conclusion MMF should be reduced or suspended when liver function abnormality occurred in patients with hepatitis C after kidney transplantation, and immediate intravenous therapy for liver protection may prove beneficial.