中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2011年
3期
159-162
,共4页
陈栋%张伟杰%陈知水%曾凡军%明长生%林正斌%陈刚%刘斌%陈实
陳棟%張偉傑%陳知水%曾凡軍%明長生%林正斌%陳剛%劉斌%陳實
진동%장위걸%진지수%증범군%명장생%림정빈%진강%류빈%진실
他克莫司%肾移植%慢性移植肾肾病
他剋莫司%腎移植%慢性移植腎腎病
타극막사%신이식%만성이식신신병
Tacrolimus%Kidney transplantation%Chronic allograft nephropathy
目的 探讨由环孢素A(CsA)转换为他克莫司(Tac)为主的免疫抑制方案对慢性移植肾肾病(CAN)患者的治疗效果.方法 选择接受同种肾移植后发生CAN的患者153例,患者肾移植后均采用CsA、吗替麦考酚酯(MMF)及泼尼松(Pred)的免疫抑制方案.根据是否以Tac替换CsA将患者分为两组.(1)CsA组:45例,进入研究后患者维持原免疫抑制方案.(2)Tac组:108例,进入研究后将CsA转换为Tac,停用CsA后立即开始服用Tac,MMF和Pred的用法同CsA组.对所有患者随访12个月,观察人/移植肾存活率、急性排斥反应发生率、移植肾功能、24 h尿蛋白定量、移植肾穿刺病理学活检及免疫抑制剂的不良反应等指标.结果 随访12个月时,CsA组和Tac组患者存活率均为100%,移植肾存活率分别为86.6%和93.5%(P＜0.05);急性排斥反应发生率分别为4.4%(2/45)和3.7%(4/108)(P＞0.05),6例发生急性排斥反应的患者均经甲泼尼龙冲击治疗3 d后逆转.Tac组患者移植肾功能明显改善,并且出现重度蛋白尿、重度肾间质纤维化和肾小管萎缩的患者比例较CsA组显著减少(P＜0.05).Tac组有13.8%(15例)的患者出现轻度血糖增高,发生率显著高于CsA组的4.4%(2例)(P＜0.05);Tac组有22.2%(24例)的患者发生高血压,发生率显著低于CsA组的55.6%(25例)(P＜0.05);17例因使用CsA而出现牙龈增生和多毛症者,经转换治疗后,症状均明显好转.结论 由CsA转换为Tac为主的免疫抑制方案能够显著改善CAN患者的移植肾功能,延缓CAN的发展,转换过程中未发生严重Tac不良反应并且改善了使用CsA时出现的不良反应.
目的 探討由環孢素A(CsA)轉換為他剋莫司(Tac)為主的免疫抑製方案對慢性移植腎腎病(CAN)患者的治療效果.方法 選擇接受同種腎移植後髮生CAN的患者153例,患者腎移植後均採用CsA、嗎替麥攷酚酯(MMF)及潑尼鬆(Pred)的免疫抑製方案.根據是否以Tac替換CsA將患者分為兩組.(1)CsA組:45例,進入研究後患者維持原免疫抑製方案.(2)Tac組:108例,進入研究後將CsA轉換為Tac,停用CsA後立即開始服用Tac,MMF和Pred的用法同CsA組.對所有患者隨訪12箇月,觀察人/移植腎存活率、急性排斥反應髮生率、移植腎功能、24 h尿蛋白定量、移植腎穿刺病理學活檢及免疫抑製劑的不良反應等指標.結果 隨訪12箇月時,CsA組和Tac組患者存活率均為100%,移植腎存活率分彆為86.6%和93.5%(P＜0.05);急性排斥反應髮生率分彆為4.4%(2/45)和3.7%(4/108)(P＞0.05),6例髮生急性排斥反應的患者均經甲潑尼龍遲擊治療3 d後逆轉.Tac組患者移植腎功能明顯改善,併且齣現重度蛋白尿、重度腎間質纖維化和腎小管萎縮的患者比例較CsA組顯著減少(P＜0.05).Tac組有13.8%(15例)的患者齣現輕度血糖增高,髮生率顯著高于CsA組的4.4%(2例)(P＜0.05);Tac組有22.2%(24例)的患者髮生高血壓,髮生率顯著低于CsA組的55.6%(25例)(P＜0.05);17例因使用CsA而齣現牙齦增生和多毛癥者,經轉換治療後,癥狀均明顯好轉.結論 由CsA轉換為Tac為主的免疫抑製方案能夠顯著改善CAN患者的移植腎功能,延緩CAN的髮展,轉換過程中未髮生嚴重Tac不良反應併且改善瞭使用CsA時齣現的不良反應.
목적 탐토유배포소A(CsA)전환위타극막사(Tac)위주적면역억제방안대만성이식신신병(CAN)환자적치료효과.방법 선택접수동충신이식후발생CAN적환자153례,환자신이식후균채용CsA、마체맥고분지(MMF)급발니송(Pred)적면역억제방안.근거시부이Tac체환CsA장환자분위량조.(1)CsA조:45례,진입연구후환자유지원면역억제방안.(2)Tac조:108례,진입연구후장CsA전환위Tac,정용CsA후립즉개시복용Tac,MMF화Pred적용법동CsA조.대소유환자수방12개월,관찰인/이식신존활솔、급성배척반응발생솔、이식신공능、24 h뇨단백정량、이식신천자병이학활검급면역억제제적불량반응등지표.결과 수방12개월시,CsA조화Tac조환자존활솔균위100%,이식신존활솔분별위86.6%화93.5%(P＜0.05);급성배척반응발생솔분별위4.4%(2/45)화3.7%(4/108)(P＞0.05),6례발생급성배척반응적환자균경갑발니룡충격치료3 d후역전.Tac조환자이식신공능명현개선,병차출현중도단백뇨、중도신간질섬유화화신소관위축적환자비례교CsA조현저감소(P＜0.05).Tac조유13.8%(15례)적환자출현경도혈당증고,발생솔현저고우CsA조적4.4%(2례)(P＜0.05);Tac조유22.2%(24례)적환자발생고혈압,발생솔현저저우CsA조적55.6%(25례)(P＜0.05);17례인사용CsA이출현아간증생화다모증자,경전환치료후,증상균명현호전.결론 유CsA전환위Tac위주적면역억제방안능구현저개선CAN환자적이식신공능,연완CAN적발전,전환과정중미발생엄중Tac불량반응병차개선료사용CsA시출현적불량반응.
Objective To investigate the effect of conversion from cyclosporine A (CsA) to tacrolimus (Tac) on chronic allograft nephropathy (CAN). Methods 153 CAN patients undergoing kidney transplantation received CsA, mycophenolate mofetil (MMF) and prednisone (CsA-MMF-Pred) regimen after kidney transplantation, and divided into 2 groups according to whether CsA were maintained in the immunosuppressive regimen: CsA + MMF + Pred group (CsA group, n = 45); Tac + MMF + Pred group (Tac group, n = 108). The patients were followed up with patient/kidney survival rate, acute rejection incidence, renal function, 24-h proteinuria and adverse events of immunosuppressive drugs for 12 months. Results Compared with CsA group, the transplanted kidney survival rate was significantly higher in Tac group (93. 5 % vs 86.6 %, P＜0. 05). Acute rejection (AR) was diagnosed in 4. 4 % (2/45) of recipients in CsA group and 3. 7 % (4/108) in Tac group (P＞0. 05) respectively. Acute rejection (2 cases in CsA group and 4 in Tac group) was reversed by 500 mg of methylprednisolone for consecutive 3 days, and the patients in Tac group showed a significantly lower degree of interstitial fibrosis and tubular atrophy (IF/TA) (P＜0. 05).Renal allograft functions and 24-h proteinuria during a follow-up period of 12 months were significantly improved in Tac group (P ＜ 0. 05). Incidence of mild hyperglycemia in Tac Group (13.8 %, 15/108) was significantly higher than in CsA group (4.4 %, 2/45), and that of hypertension in Tac group (22. 2 %, 24/108) was significantly lower than in CsA group (55.6 %,25/45). CsA-related side effects (such as hirsutism and gingival hypertrophy) in 17 patients were greatly improved after conversion from CsA to Tac treatment. Conclusion The conversion from CsA to Tac on the patients with CAN can improve renal allograft function, retard the progression of renal allograft dysfunction, reduce the incidence of CsA-related side effects and not generate serious adverse effects of Tac.
