肾移植早期应用吗替麦考酚酯与麦考酚钠肠溶片的临床对照研究  

Clinical study of individual application of different mycophenolic acid preparations in early renal transplantation

作　　者：吕广娜 宁媛 王明君 郭文萍 郭晓红 韩雪鸿 李宁 Lyu Guangna;Ning Yuan;Wang Mingjun;Guo Wenping;Guo Xiaohong;Han Xuehong;Li Ning(Department of Kidney Transplantation,The Second People's Hospital of Shanxi Province,Taiyuan 030012,China)

机构地区：[1]山西省第二人民医院肾移植中心,太原030012

出　　处：《山西医药杂志》2024年第24期1843-1849,共7页Shanxi Medical Journal

基　　金：山西省卫生健康委员会项目(2021136)。

摘　　要：目的分析比较吗替麦考酚酯(MMF)与麦考酚钠肠溶片(EC-MPS)在肾移植早期应用的临床效果,指导个体化用药。方法回顾性分析我院329例肾移植受者,按服用药物不同分为MMF组(202例)和EC-MPS组(127例)。比较2组肾移植术后1月内外周血细胞和估算肾小球滤过率(eGFR),霉酚酸药时曲线下面积(MPA-AUC)达标率,骨髓抑制、急性排斥反应(AR)、移植肾功能延迟恢复(DGF)、消化道不良反应、感染的发生率。结果2组在肾移植后3 d、7 d、14 d、30 d各时间点的外周血白细胞、淋巴细胞、血红蛋白、eGFR水平差异均无统计学意义(P>0.05);MMF组与EC-MPS组在移植后3 d的血小板差异无统计学意义,但在移植后7 d、14 d、30 d,MMF组的血小板低于EC-MPS组,差异具有统计学意义,2组血小板减少的发生率分别为21.3%和12.6%,差异具有统计学意义(P<0.05);MMF组和EC-MPS组白细胞减少的发生率分别为10.4%、12.6%,AR的发生率分别为16.8%、17.3%,DGF的发生率分别为12.4%、14.2%,消化道不良反应发生率分别为6.9%、6.3%,感染的发生率分别为17.8%、14.2%,差异均无统计学意义(P>0.05);术后7 d MPA-AUC达标率MMF组和EC-MPS组分别为55.9%和41.7%,差异具有统计学意义(P<0.05)。结论肾移植早期MMF对血小板的抑制作用强于EC-MPS,MPA-AUC达标率MMF高于EC-MPS,因此,临床需根据移植受者的免疫风险、是否存在血小板减少症等个体化选择两种霉酚酸制剂。Objective To compare the clinical effects of mycophenolate mofetil(MMF)and mycophenolate sodium enteric-coated tablets(EC-MPS)in the early postoperative period after renal transplantation.Methods A retrospective analysis was performed on 329 kidney transplant recipients in our hospital,who were divided into MMF group(202 cases)and EC-MPS group(127 cases)according to different medications.Peripheral blood cells and estimated glomerular filtration rate(eGFR),the area under the curve of mycophenolic acid(MPA-AUC)compliance rate,the incidences of myelosuppression,acute rejection(AR),delayed recovery of transplanted renal function(DGF),gastrointestinal adverse reactions,and infection were compared between the two groups within 1month after renal transplantation.Results There were no significant differences in the levels of peripheral blood white blood cells,lymphocytes,hemoglobin,and eGFR at 3,7,14,and 30 days after renal transplantation between the two groups(P>0.05).At 3 days after transplantation,there was no statistical difference in platelets between the MMF group and EC-MPS group,but at 7 days,14 days,and 30 days after transplantation,the platelets in the MMF group were lower than those in EC-MPS group,with a statistical difference.The incidence of thrombocytopenia in 1 month between the two groups was 21.3%and 12.6%,respectively,with statistical differences(P<0.05).In MMF group and EC-MPS group,the incidence of leukopenia was 10.40%and 12.6%,the incidence of AR was 16.8%and 17.3%,the incidence of DGF was 12.4% and 14.2%,the incidence of gastrointestinal adverse reactions was 6.9%and 6.30%,and the incidence of infection was 17.8% and 14.2%,respectively,with no statistical difference(P>0.05).The compliance rate of MPA-AUC 7 days after renal transplantation was 55.9% and 41.7%in the MMF and EC-MPS groups,respectively,with statistical differences(P<0.05).Conclusion In the early stage of renal transplantation,MMF has a stronger inhibitory effect on platelets than EC-MPS,and MMF has a higher compliance rate of MPA-AU

关 键 词：吗替麦考酚酯 麦考酚钠肠溶片 肾移植 不良反应 个体化治疗 

分 类 号：R699.2[医药卫生—泌尿科学]