阿兹夫定用于肾移植术后中型新冠病毒感染的疗效分析

Effectiveness of azvudine for moderate SARS-CoV-2 infection after kidney transplantation

摘要:

目的 探讨阿兹夫定治疗肾移植术后中型新冠病毒感染的有效性和安全性。方法 选取2022年12月—2024年6月广西壮族自治区人民医院移植科收治的67例肾移植术后中型新冠病毒感染患者的临床资料，根据抗新冠病毒药物种类分为阿兹夫定组（41例）和莫诺拉韦组（26例），并对比分析两组患者临床症状缓解耗时、新冠病毒核酸拷贝量转阴/降低耗时、病情等级、肝功能、肌酐、凝血功能、重症、死亡，不良反应等指标。结果 两组患者性别构成、年龄、术前透析时间、术前透析类型、基础疾病、术后发病时间、感染前他克莫司目标浓度、感染后他克莫司目标浓度、混合型感染、入院WHO临床进展量表评分、入院咽拭子新冠病毒核酸ORF基因和N基因拷贝量、甲强龙和人免疫球蛋白连用天数构成比较，差异均无统计学意义（P >0.05）。两组患者临床症状好转耗时、肺部CT病变减少耗时、重症病例、死亡病例、病情最高等级WHO评分、新冠核酸或抗原转阴耗时、新冠核酸拷贝降低耗时、入院和出院白细胞、入院和出院C-反应蛋白、入院和出院降钙素原比较，差异均无统计学意义（P >0.05）。两组患者入院和出院谷丙转氨酶、入院和出院总胆红素、入院和出院凝血酶原时间、入院和出院肌酐、不良反应事件构成比较，差异均无统计学意义（P >0.05）。两组患者不良反应发生率比较，差异无统计学意义（P >0.05）。结论 阿兹夫定治疗肾移植术后中型新冠病毒感染者是安全有效的，临床疗效不低于莫诺拉韦。

Abstract:

Objective To explore the effectiveness and safety of azvudine for moderate SARS-CoV-2 infection after kidney transplantation.Methods The clinical data of 67 patients with moderate SARS-CoV-2 infection after kidney transplantation treated in the Department of Transplantation of the People's Hospital of Guangxi Zhuang Autonomous Region during December 1, 2022 and June 30, 2024 were collected. According to the type of anti-SARS-CoV-2 medication administered, the patients were divided into the azvudine group (41 cases) and the molnupiravir group (26 cases). Comparative analyses were performed between the two groups regarding the time to clinical symptom relief, time to SARS-CoV-2 nucleic acid negativity or reduction in viral load, disease severity, liver function, creatinine levels, coagulation function, incidence of severe disease, mortality, and adverse events.Results No statistically significant differences were observed between the two groups in terms of sex distribution, age, preoperative dialysis duration, dialysis modality, underlying diseases, time from transplantation to infection onset, target tacrolimus concentrations before and after infection, mixed infections, WHO Clinical Progression Scale scores on admission, SARS-CoV-2 ORF and N gene copy numbers from throat swabs on admission, or the combined use of methylprednisolone and intravenous immunoglobulin (P > 0.05). There were also no statistically significant differences between the two groups in the time to clinical symptom improvement, time to reduction of pulmonary CT lesions, incidence of severe cases, mortality, highest WHO clinical progression scale scores, time to SARS-CoV-2 nucleic acid or antigen negativity, time to reduction in viral nucleic acid copy number, white blood cell counts on admission and discharge, C-reactive protein levels on admission and discharge, or procalcitonin levels on admission and discharge (P > 0.05). In addition, no statistically significant differences were found between the two groups regarding alanine aminotransferase, total bilirubin, prothrombin time, creatinine levels on admission and discharge, or the composition of adverse events (P > 0.05). The incidence of adverse events was also comparable between the two groups (P > 0.05).Conclusion Azvudine is safe and effective for the treatment of moderate COVID-19 infection in kidney transplant recipients and demonstrates clinical efficacy that is not inferior to molnupiravir.