肾移植后因免疫抑制剂的不良反应转换应用咪唑立宾的效果

Effect of conversion therapy to Mizoribine due to adverse reaction of immunosuppressant after renal transplantation

目的探讨肾移植术后因不良反应而将吗替麦考酚酯（MMF）或硫唑嘌呤（Aza）转换为咪唑立宾（MZR）的有效性和安全性。方法56例肾移植受者术后发生肺部感染23例，骨髓抑制14例，肝功能损害6例，腹泻13例。所有患者均采用以钙调磷酸酶抑制剂（CNI）＋MMF（或Aza）＋泼尼松（Pred）的免疫抑制方案，出现不良反应时，转换应用了CNI＋MZR＋Pred。转换治疗后随访（33．2±17．4）个月（11～53个月），观察转换治疗后的效果和不良反应。结果转换治疗后，23例肺部感染的患者，1例再次出现肺部感染，死于心、肺功能衰竭，其余均未再出现肺部感染；骨髓抑制的14例患者中，13例血常规恢复正常，1例未恢复；肝功能损害的6例患者经转换治疗后，肝功能均恢复正常；13例腹泻患者的症状均缓解。转换前，患者血清肌酐为（123±21．3）μmol／L，转换后，血清肌酐为（119±18．2）μmol／L，二者比较，差异无统计学意义（P〉0．05）。转换治疗后，有1例（1．7％）患者发生排斥反应，9例（16．1％）出现不同程度的血尿酸升高，1例出现指（No）关节疼痛等症状，均经对症治疗后好转。结论在肾移植术后发生免疫抑制剂不良反应时，转换应用咪唑立宾效果良好，安全性高，为肾移植后患者的个体化免疫抑制方案的应用提供一种新的选择。

Objective To investigate the efficacy and safety of conversion therapy to mizoribine （MZR） for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI ＋ MZR ＋ Pre when the adverse reaction occurred. During the follow-up period （11 to 53 months）, the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13 cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ＋ 21.3 μmol/L and 119 ＋ 18. 2μmol/L before and after the conversion therapy respectively （P〉0. 05）. During the follow-up period, all patients＇ graft function was good. The incidence of rejection was 1.7 % （1 case）. Nine patients （16. 1 %） had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.