| 摘要: |
| ［摘要］ 目的 分析肾移植人群中应用Paxlovid治疗新型冠状病毒感染（COVID-19）的安全性与有效性。方法 回顾性分析2022年12月1日至2023年2月28日在清华大学附属北京清华长庚医院肾移植科诊断为新型冠状病毒感染的同种异体肾移植受者的临床资料，其中接受Paxlovid治疗（Paxlovid组）的肾移植受者16例，未接受Paxlovid治疗（常规治疗组）的肾移植受者54例。分析患者COVID-19转归、感染前后的血清肌酐（Scr）、尿蛋白水平，以及他克莫司与Paxlovid相互作用特点。结果 所有患者确诊并开始治疗后，症状均逐步好转，无复发和死亡病例。Paxlovid组感染后第7天Scr显著高于常规治疗组，但感染后第14天、第30天两组Scr差异无统计学意义（P>0.05）。Paxlovid组和常规治疗组在感染前、感染后第14天、第30天的蛋白尿比例差异均无统计学意义（P>0.05）。Paxlovid组和常规治疗组COVID-19重型患者比例分别为37.50%（6/16）和0.00%（0/54），差异有统计学意义（P<0.001）。Paxlovid组的他克莫司谷浓度总体水平平稳，2例患者停用他克莫司口服Paxlovid期间，他克莫司血药浓度仍维持在10 ng/ml以上；2例患者恢复口服他克莫司后血药浓度高达20 ng/ml以上。结论 肾移植受者发生COVID-19后给予Paxlovid治疗能有效预防重症患者病情恶化，并有助于控制肾移植受者COVID-19引起的Scr升高，减轻COVID-19引起的肾功能损伤，安全性好。 |
| 关键词: 肾移植 新型冠状病毒感染 Paxlovid 奈玛特韦 利托那韦 |
| DOI：10.3969/j.issn.1674-3806.2023.10.05 |
| 分类号:R 617 |
| 基金项目: |
|
| Analysis on the efficacy of Paxlovid in treatment of COVID-19 after kidney transplantation: a single center experience |
|
YE Jun-sheng, LIN Fen-wang, XIE Jun-jie, et al.
|
|
Department of Kidney Transplantation, Beijing Tsinghua Changgung Hospital(BTCH) Affiliated to Tsinghua University, Beijing 102218, China
|
| Abstract: |
| ［Abstract］ Objective To analyse the safety and effectiveness of applying Paxlovid in treatment of coronavirus disease 2019(COVID-19) in renal transplant recipients. Methods The clinical data of allograft renal transplant recipients diagnosed with COVID-19 in the Department of Kidney Transplantation of Beijing Tsinghua Changgung Hospital(BTCH) Affiliated to Tsinghua University from December 2022 to February 2023 were retrospectively analyzed. Among them, 16 renal transplant recipients received treatment of Paxlovid(Paxlovid group) and the other 54 renal transplant recipients did not receive the treatment of Paxlovid(conventional treatment group). The outcomes of the COVID-19 patients, serum creatinine(Scr) and urine protein levels before and after infection, and the interaction between tacrolimus and Paxlovid were analyzed. Results A definite diagnosis of COVID-19 was made in all the patients and their symptoms improved gradually after starting treatment, with no relapse and dead cases. The level of Scr in the Paxlovid group on the 7th day after infection was significantly higher than that in the conventional treatment group. However, there were no significant differences in the levels of Scr on the 14th day and the 30th day after infection(P>0.05). There were no significant differences in the proportional values of proteinuria between the Paxlovid group and the conventional treatment group before infection, on the 14th day and the 30th day after infection(P>0.05). The proportional values of severe COVID-19 patients in the Paxlovid group and the conventional treatment group were 37.50 %(6/16) and 0.00%(0/54), respectively, with a statistically significant difference(P<0.001). The overall levels of tacrolimus trough concentration in the Paxlovid group were stable. During the oral administration of Paxlovid while withdrawing tacrolimus, the blood concentration of tacrolimus remained above 10 ng/ml in 2 patients, and above 20 ng/ml in the 2 patients who resumed oral tacrolimus. Conclusion The administration of Paxlovid in renal transplant recipients after suffering from COVID-19 can effectively prevent the deterioration of patients with severe COVID-19, and is conducive to controlling the increase of Scr caused by COVID-19 in the renal transplant recipients, and helps to alleviate the renal function damage caused by COVID-19, with good safety. |
| Key words: Kidney transplantation Coronavirus disease 2019(COVID-19) Paxlovid Nirmatrelvir Ritonavir |
