肾移植术后吗替麦考酚酯和硫唑嘌呤导致白细胞减少症的临床分析

The clinical analysis for leukopenia caused by using MMF and Aza after renal transplantation

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patients took MMF and 9 patients took Aza.（1）Mild and middle degrees：the dosa of MMF or Aza was decrased to half or withdrawn,then changed to other immunosuppressive agents,with taking oral leukocyte increasing agents.（2）Severe degree：MMF or Aza was withdrawn,and rhG-CSF was applied.（3） Extremely severe degree：MMF or Aza was withdrawn,high-dose rhG-CSF was applied,and steps were taken to prevent infection and support therapy.Results Mild and middle degree：21 cases were cured（recovery rate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.