中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2010年
1期
42-45
,共4页
刘双德%王洪伟%田川%焉杰克%徐东升%刘晓立%张荣梅%赵升田
劉雙德%王洪偉%田川%焉傑剋%徐東升%劉曉立%張榮梅%趙升田
류쌍덕%왕홍위%전천%언걸극%서동승%류효립%장영매%조승전
肾移植%性腺甾类激素%免疫抑制法%环孢菌素类
腎移植%性腺甾類激素%免疫抑製法%環孢菌素類
신이식%성선치류격소%면역억제법%배포균소류
Kidney transplantation%Gonadal steroid hormones%Immunosuppression%Cyclosporine
目的 评价中老年肾移植患者早期撤除激素的安全性及有效性. 方法 80例中老年肾移植患者随机分为撤激素组39例和常规治疗组41例.所有患者开始均采用环孢素A(CsA)+吗替麦考酚酯(MMF)+泼尼松(Pred)三联免疫抑制方案,Pred开始剂量为20 mg/d,撤激素组Pred逐渐减量(每周减量5 mg),术后1个月停用;常规治疗组Pred 3个月后减量为10 mg/d,6个月后减为5 mg/d维持.MMF、CsA起始用量相同.随访观察患者急性排斥反应(AR)发生率、移植肾功能、人存活率、肾存活率,感染情况、血糖、血压、体质量、血脂等指标. 结果 撤激素组、常规治疗组AR发生率相似(分别为23.1%和19.5%,χ~2=0.15,P>0.05).两组患者1、2、3年人存活率分别为97.4%、94.8%、88.0 0A和97.6%、97.6%、87.8%,差异无统计学意义(χ~2=0.1 7,P>0.05);肾存活率分别为94.9%、88.6%、83.7%和95.1%、91.5%、79.5%,差异无统计学意义(χ~2=0.07,P>0.05). 结论 老年肾移植患者早期撤除激素是可行的.
目的 評價中老年腎移植患者早期撤除激素的安全性及有效性. 方法 80例中老年腎移植患者隨機分為撤激素組39例和常規治療組41例.所有患者開始均採用環孢素A(CsA)+嗎替麥攷酚酯(MMF)+潑尼鬆(Pred)三聯免疫抑製方案,Pred開始劑量為20 mg/d,撤激素組Pred逐漸減量(每週減量5 mg),術後1箇月停用;常規治療組Pred 3箇月後減量為10 mg/d,6箇月後減為5 mg/d維持.MMF、CsA起始用量相同.隨訪觀察患者急性排斥反應(AR)髮生率、移植腎功能、人存活率、腎存活率,感染情況、血糖、血壓、體質量、血脂等指標. 結果 撤激素組、常規治療組AR髮生率相似(分彆為23.1%和19.5%,χ~2=0.15,P>0.05).兩組患者1、2、3年人存活率分彆為97.4%、94.8%、88.0 0A和97.6%、97.6%、87.8%,差異無統計學意義(χ~2=0.1 7,P>0.05);腎存活率分彆為94.9%、88.6%、83.7%和95.1%、91.5%、79.5%,差異無統計學意義(χ~2=0.07,P>0.05). 結論 老年腎移植患者早期撤除激素是可行的.
목적 평개중노년신이식환자조기철제격소적안전성급유효성. 방법 80례중노년신이식환자수궤분위철격소조39례화상규치료조41례.소유환자개시균채용배포소A(CsA)+마체맥고분지(MMF)+발니송(Pred)삼련면역억제방안,Pred개시제량위20 mg/d,철격소조Pred축점감량(매주감량5 mg),술후1개월정용;상규치료조Pred 3개월후감량위10 mg/d,6개월후감위5 mg/d유지.MMF、CsA기시용량상동.수방관찰환자급성배척반응(AR)발생솔、이식신공능、인존활솔、신존활솔,감염정황、혈당、혈압、체질량、혈지등지표. 결과 철격소조、상규치료조AR발생솔상사(분별위23.1%화19.5%,χ~2=0.15,P>0.05).량조환자1、2、3년인존활솔분별위97.4%、94.8%、88.0 0A화97.6%、97.6%、87.8%,차이무통계학의의(χ~2=0.1 7,P>0.05);신존활솔분별위94.9%、88.6%、83.7%화95.1%、91.5%、79.5%,차이무통계학의의(χ~2=0.07,P>0.05). 결론 노년신이식환자조기철제격소시가행적.
Objective To evaluate the safety and validity of an early steroid withdrawal protocol including cyclosporine (CsA) and mycophenolate mofetil (MMF) in middle aged and elderly renal transplant patients. Methods Between September 2000 and April 2008, the prospective, randomized study design was used in 80 middle aged and elderly renal transplant patients. Steroid withdrawal group (n=39) with primary cadaveric kidney transplants received a protocol consisting of CsA 4～6 mg·kg~(-1)·d~(-1) beginning at postoperative day 3, MMF 0. 75 g twice a day from the next postoperative day, and methylprednisolone (MP) 500 mg daily from day 0 to 3. Then prednisone (Pred) 20 mg daily was gradually tapered and withdrawn after postoperative day 30. Conventional steroid treatment group (control group, n=41) received a regimen consisting of CsA, MMF and MP, and Pred 20 mg daily. Pred was tapered to 5 mg daily over a period of 6 months, then maintained thereafter. Outcome parameters were patient and graft survival rates, renal function, acute rejection ( AR), arterial hypertension, hyperlipidemia or diabetes mellitus, weight gain and infection. Results The incidence of AR in the steroid withdrawal group was similar to the control group (23. 1% vs. 19. 5%, χ~2=0. 15,P>0. 05). Patient survival rates at 12, 24, 36 months were 97. 4%, 94. 8% and 88.0% in the steroid withdrawal group and were 97.6%, 97.6 and 87.8% in the control group, respectively (χ~2=0. 17, P>0. 05). And graft survival rates were 94. 9%, 88. 6% and 83. 7% in the steroid withdrawal group and were 95. 1%, 91. 5% and 79. 5% in control group, respectively (χ~2 = 0.07, P>0. 05). Conclusions In middle aged and elderly renal transplant patients, early steroid withdrawal is feasible and may not significantly increase the risk of acute rejection episodes.
