大剂量咪唑立宾联合环孢素预防肾移植术后巨细胞病毒感染：随机对照

Large-dose mizoribine in combination with cyclosporine prevents cytomegalovirus infection after kidney transplantation:A randomized controlled study

目的:体外研究显示大剂量咪唑立宾具有抑制巨细胞病毒复制的作用。文章拟验证大剂量咪唑立宾联合环孢素对肾移植术后巨细胞病毒感染的预防作用及其安全性。方法:①实验对象:选择2006-06/2007-02于解放军总医院第三○九临床部泌尿外科首次行肾移植的受者30例,对实验及治疗方案均知情同意,且得到医院伦理道德委员会批准。②实验分组及方法:将30例受者按随机数字表法分成2组,咪唑立宾组(n=15):环孢素+咪唑立宾+醋酸泼尼松;对照组(n=15):环孢素+麦考酚酸酯+醋酸泼尼松。③实验评估:观察肾移植术后90d两组受者巨细胞病毒感染、排斥反应、骨髓抑制和高尿酸血症发生情况。结果:30例受者全部进入结果分析。术后90d咪唑立宾组受者的巨细胞病毒感染率低于对照组(P=0.047),两组急性排斥反应、骨髓抑制、高尿酸血症发生率差异无显著性意义(P>0.05)。结论:使用剂量为3mg/(kg·d)的咪唑立宾可以降低巨细胞病毒感染率,同时能有效预防急性排斥反应发生,且不会加重咪唑立宾的毒副作用。

AIM：In vitro study demonstrated that large dose of mizoribine can inhibit cytomegalovirus replication. The study was aimed to analyze whether maximum allowable dose mizoribine combined with cyclosporine depressed the incidence of cytomegalovirus infection and the maximum allowable dose mizoribine security in kidney transplantation recipients. METHODS： ①Thirty patients who received kidney transplantation were enrolled at Department of Urinary Surgery, 309 Clinical Department of General Hospital of Chinese PLA from June 2006 to February 2007. All patients singed informed consents of the experiment and treatment scheme. The experiment was approved by Hospital Ethical Committee. ②Thirty recipients were assigned into 2 groups. Patients in a mizoribine group （n=15） were treated with cyclosporine （CSA）, mizoribine （MZR） and prednisone （Pred）; and patients in a control group （n=15） were treated with CSA, mycophenolate mofetil （MMF） and Pred. ③The incidence of 90-day cytomegalovirus infection, acute rejection, bone marrow depression and hyperuricacidemia were observed after transplantation. RESULTS： Thirty recipients were included in the final analysis. Cytomegalovirus infection rate was lower in the mizoribine group than in the control group （P=0.047） 90 days after transplantation. No significant difference in acute rejection, bone marrow depression and hyperuricacidemia was detected in both groups （P 〉 0.05）. CONCLUSION： Mizoribine （3 mg/kg per day） effectively decreases the incidence of cytomegalovirus infection, prevents acute rejection. In addition, it does not aggravate the by-effect of mizoribine.