摘要
目的探讨肾移植术后服用吗替麦考酚酯(MMF)和硫唑嘌呤(Aza)导致白细胞减少症的治疗策略。方法肾移植术后白细胞减少症31例;服用MMF22例,Aza9例。将白细胞减少症分为4度:轻度:WBC<4×109/L;中度:WBC<3×109/L;重度:WBC<2×109/L;极重度:WBC<1×109/L,根据不同程度采取不同处理措施:(1)轻、中度白细胞减少(21例):MMF和Aza减量到1/2或停用MMF或Aza,换用其他免疫抑制剂;口服升白细胞药物。(2)重度白细胞减少(5例):停用MMF或Aza;应用重组人粒细胞刺激因子(rhG-CSF)。(3)极重度白细胞减少(5例):停用MMF或Aza及其他免疫抑制剂;大剂量应用rhG-CSF;预防感染、加强支持治疗等。结果轻、中度白细胞减少21例:治愈21例(100%)。重度减少5例:治愈5例(100%)。极重度减少5例:治愈3例(60%),死亡2例,死于多部位感染1例,死于伤口感染大出血1例。结论及时采取适当的措施后绝大多数白细胞减少可被逆转,最有力的手段是大剂量应用rhG-CSF,停用免疫抑制剂,抗生素预防感染。
Objective To investigate the therapeutic strategy to treat leukopenia caused by using MMF and Aza after renal transplantation.Methods Among 31 patients with leukopenia after renal transplantation,22 patients took MMF and 9 patients took Aza.(1)Mild and middle degrees:the dosa of MMF or Aza was decrased to half or withdrawn,then changed to other immunosuppressive agents,with taking oral leukocyte increasing agents.(2)Severe degree:MMF or Aza was withdrawn,and rhG-CSF was applied.(3) Extremely severe degree:MMF or Aza was withdrawn,high-dose rhG-CSF was applied,and steps were taken to prevent infection and support therapy.Results Mild and middle degree:21 cases were cured(recovery rate 100%),Severe degree:5 cases were cured(recovery rate 100%),Extremely severe degree:3 of 5 cases were cured (recovery rate 60%),1 case complicating pulmonary infection was cured after antibiotic and anti-fungi therapy,and 1 case complicating DGF with hemorrhage of upper digestive tract was cured after receiving therapy of inhibiting gastric acid,blood infusion;1 case complicating DGF with rupture of the donor received the operation of nephrectomy,and restarted to dialysis.2 cases died in whom 1 case died of severe infection and 1 cases died of severe hemorrhea after wound infection.Conclusion After taking adequate measures,most of patients with leucopenia after renal transplantation can be reversed,and the most important measures are administration of rhG-CSF,withdrawal of immunosuppressive agents,and prophylactic use of antibiotics.
出处
《河北医药》
CAS
2010年第7期784-786,共3页
Hebei Medical Journal