咪唑立宾在肾移植术后的应用

Clinical application of mizoribine in minimizing virus infection risk in renal graft recipients

目的探讨咪唑立宾(MZR)在肾移植术后的临床应用效果。方法选取2003年8月至2004年4月间肾移植术后采用环孢素A(CsA)或他克莫司(FK506)+MZR+激素三联免疫抑制方案的患者112例,定期检查患者用药后的血常规、肝肾功能、尿酸、血糖、血脂等生化指标;对乙型肝炎病毒、丙型肝炎病毒、艾滋病病毒、巨细胞病毒、EB病毒、腺病毒及带状疱疹病毒进行抗原学或者抗体监测;疑有排斥反应时,行移植肾穿刺病理检查。统计病毒感染发生情况,评价该治疗方案的安全性。结果肾移植术后随访12-20个月,患者的人／肾存活率均为96％;急性排斥发生率为11．6％,经冲击治疗后全部逆转;患者主要不良反应是高尿酸血症,但可以控制而不需要停药;巨细胞病毒感染率为11．6％,未发生巨细胞病毒病;有1例感染腺病毒。结论MZR是一种安全有效的免疫抑制剂,病毒感染的发生率相对较低。由于肾移植术后应用MZR患者主要不良反应是高尿酸血症,因此要注意对患者的尿酸进行控制。

Objective To investigate the clinical application of mizoribine （MZR） in minimizing virus infection risk in renal transplant patients. Methods Four transplantation centers in Beijing par ticipated in this clinical trial, and 112 primary cadaveric renal allograft recipients were enrolled. MZR in combination with CsA and corticosteroids was used for the prevention of acute rejection （AR）. The biochemical data were observed and the infections of 7 different viruses were monitored and recorded. Results All patients were followed up for 12-20 months （average 15.5 months）. The patlent/graft survival rate was 96% and the morbidity of AR was 11.6%. All ARs were converted. The major side effect was hyperuricimia, which could be controlled without withdrawal of MZR. The morbidity of CMV infection was 11.6%and no CMV diseases occurred. Only one ease experienced adenovirus infection. Conclusions MZR is a safe and effective immunosuppressants. Hyperuricimia should be con trolled after operation. The morbidity of virus infections was relatively lowered.