论文部分内容阅读
目的探讨肾移植术后服用吗替麦考酚酯(MMF)和硫唑嘌呤(Aza)导致白细胞减少症的治疗策略。方法肾移植术后白细胞减少症31例;服用MMF22例,Aza9例。将白细胞减少症分为4度:轻度:WBC<4×109/L;中度:WBC<3×109/L;重度:WBC<2×109/L;极重度:WBC<1×109/L,根据不同程度采取不同处理措施:(1)轻、中度白细胞减少(21例):MMF和Aza减量到1/2或停用MMF或Aza,换用其他免疫抑制剂;口服升白细胞药物。(2)重度白细胞减少(5例):停用MMF或Aza;应用重组人粒细胞刺激因子(rhG-CSF)。(3)极重度白细胞减少(5例):停用MMF或Aza及其他免疫抑制剂;大剂量应用rhG-CSF;预防感染、加强支持治疗等。结果轻、中度白细胞减少21例:治愈21例(100%)。重度减少5例:治愈5例(100%)。极重度减少5例:治愈3例(60%),死亡2例,死于多部位感染1例,死于伤口感染大出血1例。结论及时采取适当的措施后绝大多数白细胞减少可被逆转,最有力的手段是大剂量应用rhG-CSF,停用免疫抑制剂,抗生素预防感染。
Objective To investigate the treatment strategies of leucopenia caused by taking mycophenolate mofetil (MMF) and azathioprine (Aza) after renal transplantation. Methods 31 cases of leukopenia after renal transplantation; 22 cases of MMF taking, 9 cases of Aza. The leukopenia was divided into 4 degrees: mild: WBC <4 × 109 / L; moderate: WBC <3 × 109 / L; severe: WBC <2 × 109 / L, according to different degrees to take different measures: (1) mild to moderate leukopenia (21 cases): MMF and Aza reduction to 1/2 or disable MMF or Aza, switch to other immunosuppressive agents; oral leukocyte drug. (2) Severe leukopenia (5 cases): MMF or Aza was discontinued; recombinant human granulocyte stimulating factor (rhG-CSF) was applied. (3) very severe leukopenia (5 cases): disable MMF or Aza and other immunosuppressive agents; high-dose rhG-CSF; prevent infection and strengthen supportive treatment. Results of mild to moderate leukopenia in 21 cases: 21 cases were cured (100%). Severe reduction in 5 cases: 5 cases were cured (100%). Severe reduction in 5 cases: 3 cases were cured (60%), 2 died, died of multiple infections in 1 case, died of wound infection in 1 case of hemorrhage. Conclusions Most of the leukopenia can be reversed after appropriate measures are taken in time. The most powerful method is to use rhG-CSF in large doses, stop using immunosuppressants and antibiotics to prevent infection.