霉酚酸酯治疗慢性移植肾肾病的探讨(附9例报告)

Experience with mycophenolate mofetil in the treatment of chronic allograft nephropathy(A report of 9 cases)

目的 :探讨霉酚酸酯 (MMF)治疗慢性移植肾肾病 (CAN)的疗效和安全性。 方法 :回顾性分析应用MMF、联合小剂量环孢素A(CsA)和强地松 (Pred)治疗 9例CAN患者的效果和并发症。 结果 :9例中有 8例患者的血清肌酐 (SCr)下降 ,治疗前和随访时SCr两组间有显著性差异 (P <0 0 5 ) ,有效率达 88% ,其中 2例因严重腹泻而被迫停用MMF。有 1例SCr升高治疗无效 ,转为血液透析。 结论 :MMF、联合小剂量CsA和Pred治疗CAN有一定效果。腹泻是应用MMF的严重副反应 ,影响了MMF的使用 。

Objective:Mycophenolate mofetil(MMF)is a promising agent for both induction and maintenance therapy in renal allograft recipients.In this report,we analyzed our experience in 9 cases of chronic allograft nephropathy(CAN)whose anti rejection therapy changed from routine cyclosporineA(CsA) azathioprine(Aza) prednison regime to low dose CsA MMF prednison regime. Methodology:Nine (8 males and 1 female)renal allograft recipients with CAN were included whose serum creatinine level increased above 200 μmol/L and 24 hour urinary protein excretion above 1 gram 12～84 months after transplantation,among them 4 recipients was proved with allograft biopsy.After the diagnosis of CAN,CsA dosage was decreased to 2～3 mg/(kg·d),and Aza replaced with MMF at 1 5 g/d. Results:Decrement of serum creatinine level was found in 8 of the 9 cases,with the after switch average level significantly lower than the pre switch average level(223 2±54 9 μmol/L vs 302 1±101 8 μmol/L).One case preceded over 6 months to end stage renal failure needing hemodialysis after the switch.Side effect of MMF regime as diarrhea was observed. Conclusion:In our experience with these nine cases,MMF combined with low dosage CsA and steroid is an effective regime for the treatment of CAN.