ISSN 1006-298X      CN 32-1425/R

导航

肾脏病与透析肾移植杂志 ›› 2013, Vol. 22 ›› Issue (6): 520-525.

• 论文 • 上一篇    下一篇

肾移植感染高危受者术后序贯切换为咪唑立宾的临床观察

  

  • 出版日期:2013-12-28 发布日期:2013-12-28

Effects of the conversion from the MMF to mizoribine after renal transplantation in the receipts of high risks of infection

  • Online:2013-12-28 Published:2013-12-28

摘要:

摘 要 目的:通过对肾移植感染高危人群序贯切换免疫抑制剂方案探讨其预防感染的效果以及对移植肾功能的影响。方法:2009年1月至2011年3月共16例肾移植术后感染高危受者(年龄>60岁,术前应用ATG诱导,术后2周内MP冲击剂量>3g,淋巴细胞计数持续小于1000/ul)入选。所有受者术前均接受诱导治疗,术后起始采用他克莫司+霉酚酸酯+强的松的免疫抑制方案,术后1~1.5月切换霉酚酸酯为咪唑立宾,持续至术后6月。观察切换前后血白细胞和淋巴细胞计数、血肌酐、血尿酸、肝功能变化;并观察切换期间急性排斥反应及感染的发生率;术后6月时受者接受移植肾常规活检,观察6月时间点移植肾病理特点。结 果:切换后血白细胞计数、淋巴细胞比例和淋巴细胞计数均有不同程度升高。切换前后血肌酐稳定,血尿酸、肝功能指标未见明显变化。观察期间内2例发生尿路感染,1例肺部感染,均治愈。全部患者均未发生重症感染发生。除1例患者凝血功能障碍外,余15例受者在6月时接受移植肾活检,其中1例为亚临床急性排斥反应, 1例临界改变,余13例均为移植肾改变。结论:肾移植术后感染高危受者更改免疫抑制治疗方案可以有效改善受者免疫功能,避免发生重症感染。切换后移植肾功能稳定,未增加排斥反应发生率。

Abstract:

ABSTRACT Objective: To observe the effect and the side-effect of the conversion from MMF to mizoribine (MZR) after renal transplantation. Methodology: Sixteen kidney recipients with high risks of infection (ATG induction before operation, age over 60 years, MP pulse over 3g, the blood lymphocyte count was less than 1000/ul) were enrolled his study. Their initial immunosuppressive protocol was tacrolimus combined with MMF and predinisone. The conversion from MMF to MZR happened during 4 to 6 weeks after operation. The period of observation lasted to six months. The WBC count, rate of lymphocyte, and the lymphocyte count in peripheral blood were collected before and after the conversion. The serum creatinine, uric acid and the liver function were collected. The acute rejection and all the kinds of infections were also collected during the observation period. The selected patients received the protocol biopsy on the sixth month. The histological and laboratory tests were analyzed during the sixth month. Results: The WBC count, rate of lymphocyte, and the lymphocyte count in peripheral blood increase after the conversion of the immunosuppressive. The serum creatinine, uric acid and the liver function were stable. One recipients experience the upper respiratory infection and 2 had urinary tract infection. None of them had the severe infection in those high risks recipients. 15 patients were performed the protocol biopsy in the six month. One was diagnosed as subclinical acute rejection with treatment of MP pulse therapy, one board line change, and the other 13 patients were normal changes. Conclusion: The conversion from MMF to MZR happened during 4 to 6 weeks after operation in the kidney recipients with high risks of infection after renal transplantation can reduced the severe infection, and which didn’t increase the rate of acute rejection, with fewer side-effect.