【摘要】 目的 :观察包括MMF在内的免疫抑制方案在慢性排斥反应的肾移植患者中的作用。方法 :由 3 6名经临床或活检证实的肾移植术后慢性排斥患者组成。在三联免疫抑制方案中 ,用MMF替代硫唑嘌呤 ,并对所有患者随访 1年 ,观察其肾功能的变化 ,并观察环孢霉素A(CSA)及泼尼松的用药剂量的变化 ,同时观察MMF药物的毒副作用。结果 :改服MMF2月时 ,已有 4 4.4 4%的患者血Cr开始下降 ,6月时已有 4 4.4 4%的患者血Cr下降 3 0 % ,1年时 3 0名 ( 83 .3 3 % )的患者血Cr水平继续保持好转趋势或保持原水平。 6名肾功能继续恶化的患者 ,其中有 5名患者肾移植术后 3年以上 ,此 6名患者在服用MMF前血Cr的浓度均高于 3mg/dl,患者服用MMF2周后开始调节CSA用量 ,一般减低CSA用量 10 %～ 3 0 % ,待肾功能平稳后 ,酌情减低泼尼松的用量 ,在随访期间未发现急性排斥反应 ,MMF药物的毒、副作用主要为消化系统、血液系统及神经系统。结论 :MMF对因慢性排斥而导致的慢性肾功能不良的患者有一定的疗效 ,尤其是轻、中度肾功能不全及肾移植术后 3年以内的患者疗效好 (短期内 ) ,但需进行长期的随访观察。在应用MMF的同时可以降低CSA及激素的用量 ,以减少CSA及激素的毒副作用。MMF药物的毒副作用是可以接受的 ,随着临床用药经验的提高 ,可能会更多还原

【Abstract】 OBJECTIVE:To observe the effects of Mycophenolate Mofetil (MMF) in regimen of immunosupression on recipients of renal transplantation with renal failure METHODS:The study was conducted in 36 patients with renal allograft dysfunction secondary to chronic allograft rejection. They were treated with triple regimen of immunosurpression in which the azthioprine was substituted by MMF and have been followed for at least 1 year. Changes in their renal function,in dosage of CSA and prednisone,and the side effects of MMF were observed. RESULTS:After MMF substitution,the creatinine (Cr) started to improve in 16 patients(44.4%) at 2 months;the average Cr decrease by 30% in 44.4% patients at 6 months;and the Cr maintained or further improved in 30 patients ( 83.3% ) at 1 year. The renal function deterioration continued in 6 patients (with a Cr level of 3 mg/dl before MMF substitution). 5 of them were recipients of real transplantation>3 years. The dose of CSA starting to deminish by 10%～30% after 2 weeks of MMF substitution,and the dose of prednisone be reduced if renal function was stable. Gastrointestinal,haematological,and neurological reactions were the major side effects of MMF. CONCLUSION:MMF appears to be effective for treatment of allograft dysfunction,especially for patients with moderate allograft dysfunction of less than 3 years of transplantation. For avoiding side effects,the dosage of CSA and prednisone may be reduced. The side effects of MMF observed are mostly reversible and within the acceptable range. The long term effects of MMF in treament of chronic renal rejection need to be determined by further follow up.更多还原