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目的:观察咪唑立宾(MZR)的免疫抑制效果及安全性,采用MZR替代麦考酚酸酯(MMF),比较环孢素A(CsA)+MZR/MMF+泼尼松龙(Pre)两种三联免疫抑制治疗的疗效。方法:尸体肾移植患者70例,按手术顺序交替登记MZR组和MMF组。移植后采用CsA+MZR/MMF+Pre三联免疫抑制疗法,MZR组剂量为200mg.d-1(体重>60kg)或150mg.d-1(体重<60kg);MMF组剂量为1500mg.d-1(体重>60kg)或1000mg.d-1(体重<60kg)。观察肾移植术后1年的人/肾存活率、急性排斥反应发生率及治疗逆转率、感染发生情况及药物毒副作用。结果:全部病例术后随访至少1年,MZR组和MMF组的急性排斥反应发生率分别为17.1%和11.4%,两组之间无显著性差异。MZR组和MMF组肺部感染的发生率分别为8.6%和48.6%,MMF组的发生率显著升高。血尿酸升高的发生率两组之间比较未见显著性差异,MZR组在术后24,36,48周时血尿酸的水平要高于MMF组。MZR组的持续用药率显著高于MMF组。结论:MZR可以与钙调神经素阻滞剂、激素联合应用于肾移植患者,具有一定的安全性和有效性,不良反应相对较少。
OBJECTIVE: To observe the immunosuppressive effect and safety of mizoribine (MZR), to compare the effect of MZR on mycophenolate mofetil (MMF) and cyclosporin A (CsA) + MZR / MMF + prednisolone The efficacy of triple immunosuppressive therapy. Methods: Seventy patients with renal allograft were randomly divided into MZR group and MMF group. After transplantation, CsA + MZR / MMF + Pre triple immunosuppressive therapy was used. The dose of MZR group was 200mg.d-1 (body weight> 60kg) or 150mg.d-1 (body weight <60kg) (Weight> 60 kg) or 1000 mg.d-1 (weight <60 kg). To observe the survival rate of human / kidney one year after renal transplantation, the incidence of acute rejection and treatment reversal rate, the incidence of infection and drug toxicity. Results: All cases were followed up for at least 1 year. The incidence of acute rejection in MZR group and MMF group was 17.1% and 11.4% respectively, with no significant difference between the two groups. The incidence of lung infections in the MZR and MMF groups was 8.6% and 48.6%, respectively, and the incidence of MMF was significantly higher in the MZR and MMF groups. The incidence of serum uric acid increased no significant difference between the two groups, MZR group at 24,36,48 weeks after the serum uric acid levels higher than the MMF group. The sustained-use rate of MZR group was significantly higher than that of MMF group. Conclusion: MZR can be combined with calcineurin blockers and hormones in renal transplant patients, which has a certain safety and effectiveness, with relatively few adverse reactions.