肾移植后硫唑嘌呤的毒性反应及其治疗

TOXIC REACTION AND MANAGEMENT OF AZATHIOPRINE IN KIDNEY TRANSPLANTATION RECIPIENTS

分析１９８５年以来２８０例肾移植患者使用硫唑嘌呤（Ａｚａ）的毒性及其治疗。所有患者均采用环孢菌素，Ａｚａ和泼尼松联合治疗，其中肝功能损害２８例和白细胞减少（〈３×１０＾９／Ｌ）１５例，肝功能损害患者中，单纯Ａｚａ肝毒性６例（２１．４％）伴环孢菌素血浓度升高９例（３２．１％）伴肝炎标志阳性１２例（４２．９％）经分析共有２０例（７１．４％）与Ａｚａ毒性有关。该２０例患者不能继续使用Ａｚａ而用环磷酰胺（

Azathioprine (Aza) toxic reaction in 280 kindey transplantation recipients who recieved cyclosporin A(CsA) combined with Aza and prednisone from 1985 to 1994 was analysed, it was found that 28 cases presented with liver function impairment and 15 cases with decrease of leucocyte (<3 X 109/L). Of the patients with liver function impairment, there were 6 cases (21.4%) liver function caused by Aza,9 cases (32.1%) with increased CsA concentration and 12 cases (42.9%) with positive antigen or antibody of hepatitis. An analysis showed 20 cases (71.4%) were related with Aza toxicity. 20 patients couldn't continue with treatment of Aza,whose liver function recoverd after treament replaced by cyclophos-phamide (Cytoxan, CTX). 9 of 15 cases with decreased leucocyte could continue recieving Aza after treament. 4 patients should take CTX in replace. These findings show Aza toxic reaction, especially the liver toxicity is significant,much attention should be paid. It is recommended that the patient with severe Aza toxic reaction should take CTX in replace.