CAJ | 학술논문

目的评价肾移植受者将环孢素A(CsA)转换为他克莫司(Tac)治疗的有效性和安全性。方法回顾将CsA转换为Tac治疗的97例肾移植受者的资料，转换治疗的原因分别为慢性移植肾肾病62例，难治性排斥反应21例，肝功能异常8例，齿龈增生、多毛6例。观察转换治疗后3年内的肾功能、肝功能、血脂、血压、血糖、急性排斥发生率、人/肾存活率以及药物不良反应等指标。结果与转换前相比较，慢性移植肾肾病及难治性排斥反应患者转换治疗1年后肾功能明显好转(P＜0.01)，患者第2、3年肾功能稳定。转换治疗后，肝功能异常者的肝功能明显改善，齿龈增生和多毛患者的症状也明显改善。97例转换治疗后第1年的人/肾存活率分别为100％和97.9％，第3年为100％和92.8％，患者血浆胆固醇、低密度脂蛋白、甘油三酯和血压均下降(P＜0.05)。转换治疗后，13例需用药物控制血糖(13.4％)，另发生腹泻和食欲不振2例(2.1％)，震颤5例(5.2％)。观察期内患者均未发生严重肺部感染和肿瘤。结论使用CsA行免疫抑制治疗的肾移植受者发生相关并发症后转换为Tac治疗是安全和有效的。
목적 평개신이식수자장배포소A(CsA)전환위타극막사(Tac)치료적유효성화안전성。방법 회고장CsA전환위Tac치료적97례신이식수자적자료，전환치료적원인분별위만성이식신신병62례，난치성배척반응21례，간공능이상8례，치간증생、다모6례。관찰전환치료후3년내적신공능、간공능、혈지、혈압、혈당、급성배척발생솔、인/신존활솔이급약물불량반응등지표。결과 여전환전상비교，만성이식신신병급난치성배척반응환자전환치료1년후신공능명현호전(P＜0.01)，환자제2、3년신공능은정。전환치료후，간공능이상자적간공능명현개선，치간증생화다모환자적증상야명현개선。97례전환치료후제1년적인/신존활솔분별위100％화97.9％，제3년위100％화92.8％，환자혈장담고순、저밀도지단백、감유삼지화혈압균하강(P＜0.05)。전환치료후，13례수용약물공제혈당(13.4％)，령발생복사화식욕불진2례(2.1％)，진전5례(5.2％)。관찰기내환자균미발생엄중폐부감염화종류。결론 사용CsA행면역억제치료적신이식수자발생상관병발증후전환위Tac치료시안전화유효적。
Objective To verify the efficacy and safety of conversion from cyclosporine (CsA) to tacrolimus (Tac) in renal transplant recipients. Methods The clinical data of conversion from CsA to Tac in renal transplant recipients were retrospectively analyzed. In 97 patients undergoing kidney transplantation, there were 62 cases of chronic allograft nephropathy (CAN), 21 cases of refractory renal allograft rejection, 8 cases of hepatic impairment, and 6 cases of gingival overgrowth and hirsutism. The patients were followed up with renal function, hepatic function, blood fat, pressure,glucose,acute rejection incidence, patients/kidney survival rate,and adverse drug reaction for 3 years.Results The renal function of patients with CAN and refractory acute rejection was greatly improved after conversion from CsA to Tac treatment at the first year (P＜0. 05) ,and steady at the 2nd or 3rd year. The conversion treatment could greatly improve the hepatic function of patients with dysfunction of liver, improve the gum hypertrophy and hypertrichosis results from CsA. The 1- and 3-year patients/kidney survival rate after conversion from CsA to Tac was 100 ％/97. 9 ％ and 100 ％/92. 8 ％, respectively. The conversion treatment showed a significantly lower degree of plasma cholesterol, low density lipoprotein, triglyceride, and blood pressure (P ＜ 0.05). Incidence of pathoglycemia, diarrhea or anepithymia,and tremor after conversion treatment was 13.4 ％ (13/97),2. 1％ (2/97) and 5. 2 ％ (5/97),respectively. There were no serious pulmonary infection and tumor during the observation period. Conclusion The mid-long term effect of conversion from CsA to Tac in patients with kidney transplantation is safe and effective.