麦考酚钠肠溶片治疗肾移植后远期吗替麦考酚酯相关慢性腹泻患者的临床疗效  

Conversion to enteric-coated mycophenolate sodium for management of long-term mycophenolate mofetil-related chronic diarrhea in patients after kidney transplantation

作　　者：孟凡航[1] 郭雪坤[1] 陈志勇[1] 赖永通[1] 黄先恩[1] 林民专[1] 

机构地区：[1]广州医科大学附属第三医院器官移植科,广东省广州市510150

出　　处：《世界华人消化杂志》2014年第30期4691-4694,共4页World Chinese Journal of Digestology

摘　　要：目的:观察肾移植术后远期吗替麦考酚酯相关慢性腹泻的药物转换效果.方法:选取广州医科大学附属第三医院器官移植科于2010-05/2014-01收治的23例肾移植术后远期吗替麦考酚酯相关慢性腹泻患者作为临床研究对象,将这些患者所用的吗替麦考酚酯转换为麦考酚钠肠溶片,并随访12 wk,对比转换前后这些患者的腹泻改善情况、血二氧化碳结合力、血钠、血钾、血肌酐、24 h尿蛋白定量等指标,采取SPSS19.0的统计学软件进行数据相关性分析,采取χ2检验评价计数资料,采取t检验评价计量资料,P<0.05为差异有统计学意义.结果:药物转换后患者的2 wk内的腹泻改善率为92.50%(111/120).血二氧化碳结合力、血钠、血钾等指标均要明显高于转换前,差异具有显著的统计学意义(P<0.05),随访12 wk,未观察到急性排斥反应,血肌酐、24 h尿蛋白定量等指标较转换前均有明显好转(P>0.05).治疗前采取胃肠道症状分级评分表(gastrointestinal symptom rating scale,GSRS)为2.3分±0.3分,治疗后GSRS评分0.5分±0.1分,差异有统计学意义(P<0.05).结论:肾移植术后远期吗替麦考酚酯相关性腹泻患者将吗替麦考酚酯及时转换为麦考酚钠肠溶片后腹泻症状明显减轻,有助于改善电解质紊乱,改善受损的移植肝功能,并未增加急性排斥反应风险,值得临床推广.AIM： To assess the effect of conversion to entericcoated mycophenolate sodium for management of long-term mycophenolate mofetil-related chronic diarrhea in renal transplant recipients. METHODS： Twenty-three renal transplant recipients with long-term mycophenolate mofetil-related chronic diarrhea treated at the Third Affiliated Hospital of Guangzhou Medical University from May 2010 to January 2014 were included in the study. After mycophenolate mofetil was converted to enteric-coated mycophenolate so-dium, these patients were followed for 12 wk. Improvement of diarrhea, blood carbon dioxide combining power, sodium, potassium, creatinine, and 24-h urine protein were monitored before and after drug conversion.RESULTS： The rate of diarrhea improvement was 92.50%（111/120） 2 wk after drug conversion. After drug conversion, blood carbon dioxide combining power, sodium, and potassium were significantly higher than before conversion（P 〈0.05）. During the follow-up period, no acute rejection was observed, and serum creatinine and 24-h urine protein were significantly better than before conversion（P〉0.05）. Gastrointestinal symptom rating scale（GSRS） score after conversion was significantly lower than before conversion（0.5 ± 0.1 vs 2.3 ± 0.3, P〈0.05）.CONCLUSION： Conversion from mycophenolate mofetil to enteric-coated mycophenolate sodium can improve chronic diarrhea, electrolyte imbalance and kidney dysfunction in renal transplant recipients.

关 键 词：肾移植 吗替麦考酚酯相关慢性腹泻 药物转换 

分 类 号：R699.2[医药卫生—泌尿科学]