肾移植后霉酚酸酯所致白细胞减少的临床分析

Clinincal analysis of the leukocytopenia caused by mycophenolate mofetil

目的 探讨肾移植后应用霉酚酸酯 (MMF)所致白细胞减少的发生机理及治疗策略。方法 对应用MMF后发生白细胞减少、须停药的 2 5例肾移植患者的资料进行回顾性分析。结果 MMF所致白细胞减少的发生率为 4 % (2 5 / 6 32 ) ,其中重度及危重度患者 13例 ,中度减少 12例 ,暂停或永久停用MMF ,重度及危重度患者应用重组人粒细胞集落刺激因子 (rhG CSF)治疗的有效率为92 % (12 / 13) ;患者停用MMF期间加用百令胶囊 6 .0～ 9.0 g/d。 结论 肾移植后应用MMF所致须停药的白细胞减少并不少见 ,其发生可能与体内血中游离的霉酚酸浓度较高有关 ;严重者可用rhG CSF治疗 ,大多数可逆 ;

Objective To retrospectively analyze the leukocytopenia caused by mycophenolate mofetil (MMF) and summarize the methods of treatment.Methods Twenty five renal transplant recipients who suffered from leukocytopenia caused by MMF were divided into three groups: moderate group, severe group and critical group. The ways of treatment and prognosis were compared among them. Results The incidence of leukocytopenia caused by MMF was 4% (25/632). The effective rate in the severe and critical groups treated with recombinant human granulocyte colony stimulating factor (rhG CSF) was 92%(12/13). To decrease the dosage of MMF could eliminate the risk of severe or critical leukocytopenia.Conclusion The drug suspensory leukocytopenia caused by MMF was not really unfrequent, but it could be treated by rhG CSF effectively. It was important to renal insufficient patients to decrease the dosage of MMF properly.