不同抗病毒治疗方案对肾移植后带状疱疹的疗效评价

Therapeutic effect of different antiviral drugs on herpes zoster after renal transplantation

目的评价阿昔洛韦、膦甲酸钠、单磷酸阿糖腺苷单独及联合应用,治疗肾移植后带状疱疹的疗效和安全性。方法回顾性分析天津市第一中心医院2010年3月至2015年6月163例肾移植后带状疱疹患者的治疗方案。根据发生带状疱疹后7 d内患者治疗方案的不同,分为阿昔洛韦组(42例)、膦甲酸钠组(34例)、单磷酸阿糖腺苷组(26例)、阿昔洛韦联合膦甲酸钠组(29例)以及阿昔洛韦联合单磷酸阿糖腺苷组(32例),比较5种治疗方案的疗效及安全性。采用单因素方差分析比较5组患者结痂时间、止痛时间及总疗程,采用配对t检验比较2组联合治疗方案患者治疗前、后白细胞计数、血小板计数及血清肌酐水平;采用χ2检验比较5组患者总有效率。P<0.05为差异有统计学意义。结果 5组患者水疱结痂时间、止痛时间及总疗程差异均有统计学意义(F=4.802、5.127、5.013,P均<0.05),阿昔洛韦组患者水疱结痂时间、止痛时间及总疗程均比单磷酸阿糖腺苷组和膦甲酸钠组患者长,差异均有统计学意义(P均<0.05)。两种联合治疗方案结痂时间、止痛时间及总疗程均比单用阿昔洛韦治疗组短,其中阿昔洛韦及单磷酸阿糖腺苷联合治疗各项时间均最短,差异具有统计学意义(P均<0.05)。阿昔洛韦联合单磷酸阿糖腺苷组患者总有效率达97%,高于其他4组。两种联合治疗方案组患者白细胞计数、血小板计数及血清肌酐水平在治疗前、后相比,差异均无统计学意义(P均>0.05)。结论阿昔洛韦及单磷酸阿糖腺苷联合治疗肾移植后带状疱疹疗效显著,不良反应少。抗病毒药物联合应用可能成为器官移植后带状疱疹治疗的更好选择。

Objective To evaluate the efficacy and safety of independent and combined application acyclovir,foscarnet sodium and vidarabine monophosphate for herpes zoster after renal transplantation. Methods From March 2010 to June 2015,a total of 163 cases of renal transplantation patients who suffered from herpes zoster were divided into different antiviral drug groups： acyclovir group, foscarnet sodium group, vidarabine monophosphate group, combined treatment group 1（ acyclovir and foscarnet sodium combined treatment）,combined treatment group 2（ acyclovir and vidarabine monophosphate combined treatment）. To compare the efficacy and safety of the five groups of drugs. Results A statistical difference was found in average of scabbing time（ P = 0. 032）,the analgesic time（ P = 0. 029） and total course（ P = 0. 030） between the five groups. The average scabbing time,the analgesic time and total course in the acyclovir group were longer than the vidarabine monophosphate group and the foscarnet sodium group. Two combination therapy groups had shorter average scabbing time,the analgesic time and total course than the acyclovir group. To evaluate the efficacy of the five groups,there was no significant difference,but the total effective rate of the acyclovir combined vidarabine monophosphate group was 97%,higher than the other four groups.White blood cell count,platelet count and serum creatinine levels in two combination therapy groupshad not obvious changed. Short-term joint use of antiviral drugs did not increase adverse reactions and kidney damage. Conclusions The combination of different antiviral drugs may be a better choice for the treatment of herpes zoster after organ transplantation.