中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2009年
7期
538-542
,共5页
王仁定%吴建永%王逸民%张建国%王苏娅%黄洪锋%何强%陈江华
王仁定%吳建永%王逸民%張建國%王囌婭%黃洪鋒%何彊%陳江華
왕인정%오건영%왕일민%장건국%왕소아%황홍봉%하강%진강화
肾移植%移植物排斥%环孢菌素%他克莫司%血清尿酸
腎移植%移植物排斥%環孢菌素%他剋莫司%血清尿痠
신이식%이식물배척%배포균소%타극막사%혈청뇨산
Kidney transplantation%Graft rejection%Cyclosporine%Tacrolimus%Serum uric acid
目的 探讨肾移植术后急性排斥发生后环孢素(CsA)切换成他克莫司(FK506)抗排斥治疗对移植肾的影响.方法 回顾性分析本中心肾移植患者发生病理证实的急性排斥86例,经过抗排斥治疗后有23例由CsA治疗切换成FKS06为基础的免疫抑制治疗(FK506组),63例继续应用CsA为基础的免疫抑制治疗(CsA组).比较两组临床资料,包括性别、年龄、冷和热缺血时间、淋巴毒、术前群体反应性抗体(PRA)水平、人类门细胞抗原(HLA)错配、血脂、血清肌酐、血尿酸、再次排斥的发生率和移植肾存活等情况.结果 抗排斥治疗后1年内再次病理证实的排斥率,FK506组显著低于CsA组[1/23(4.35%)比16/63(25.40%),P=0.0331.FKS06组急性排斥发生后5年内的移植肾存活率为100%,高于CsA组的81.4%.FK506组急性排斥发生后24个月及36个月血尿酸分别为(265.5±147.9)Ixmol/L和(245.8±88.9)μmol/L,均显著低于CsA组的(428.5±119.3)μmol/L和(441.2±125.3)μmol/L(P<0.01).结论 肾移植术后急性排斥发生后由CsA治疗切换成FK506治疗可降低再次排斥的发生率,而降低血尿酸水平有利移植肾的存活.
目的 探討腎移植術後急性排斥髮生後環孢素(CsA)切換成他剋莫司(FK506)抗排斥治療對移植腎的影響.方法 迴顧性分析本中心腎移植患者髮生病理證實的急性排斥86例,經過抗排斥治療後有23例由CsA治療切換成FKS06為基礎的免疫抑製治療(FK506組),63例繼續應用CsA為基礎的免疫抑製治療(CsA組).比較兩組臨床資料,包括性彆、年齡、冷和熱缺血時間、淋巴毒、術前群體反應性抗體(PRA)水平、人類門細胞抗原(HLA)錯配、血脂、血清肌酐、血尿痠、再次排斥的髮生率和移植腎存活等情況.結果 抗排斥治療後1年內再次病理證實的排斥率,FK506組顯著低于CsA組[1/23(4.35%)比16/63(25.40%),P=0.0331.FKS06組急性排斥髮生後5年內的移植腎存活率為100%,高于CsA組的81.4%.FK506組急性排斥髮生後24箇月及36箇月血尿痠分彆為(265.5±147.9)Ixmol/L和(245.8±88.9)μmol/L,均顯著低于CsA組的(428.5±119.3)μmol/L和(441.2±125.3)μmol/L(P<0.01).結論 腎移植術後急性排斥髮生後由CsA治療切換成FK506治療可降低再次排斥的髮生率,而降低血尿痠水平有利移植腎的存活.
목적 탐토신이식술후급성배척발생후배포소(CsA)절환성타극막사(FK506)항배척치료대이식신적영향.방법 회고성분석본중심신이식환자발생병리증실적급성배척86례,경과항배척치료후유23례유CsA치료절환성FKS06위기출적면역억제치료(FK506조),63례계속응용CsA위기출적면역억제치료(CsA조).비교량조림상자료,포괄성별、년령、랭화열결혈시간、림파독、술전군체반응성항체(PRA)수평、인류문세포항원(HLA)착배、혈지、혈청기항、혈뇨산、재차배척적발생솔화이식신존활등정황.결과 항배척치료후1년내재차병리증실적배척솔,FK506조현저저우CsA조[1/23(4.35%)비16/63(25.40%),P=0.0331.FKS06조급성배척발생후5년내적이식신존활솔위100%,고우CsA조적81.4%.FK506조급성배척발생후24개월급36개월혈뇨산분별위(265.5±147.9)Ixmol/L화(245.8±88.9)μmol/L,균현저저우CsA조적(428.5±119.3)μmol/L화(441.2±125.3)μmol/L(P<0.01).결론 신이식술후급성배척발생후유CsA치료절환성FK506치료가강저재차배척적발생솔,이강저혈뇨산수평유리이식신적존활.
Objective To investigate the effect of swifch from cyclosporine to FK506 on renal allograft outcome after initial acute rejection. Methods Clinical outcome of patients who experienced first acute rejection episode were retrospectively analyzed. After initial acute rejection, 23 patients were switched to FK506-based immunosuppression, and 63 patients continued CsA-based immunosuppression. Demographic data, lipid, serum creatinine, uric acid, incidence of recurrent acute rejection and graft survival were analyzed and compared. Results During one year after anti-rejection therapy, incidence of biopsy-proved recurrent rejection events was significantly lower with FK506 therapy (1/23, 4.35%) compared with CsA therapy (16/63, 25.40%)(P=0.033). 5-year graft survival rate of FK506-based immunosuppression group was higher than that of CsA-based immunosuppression group (100.0% vs 81.4%). Serum uric acid level of FK506-based immunosuppression group from 24 months to 36 months after initial rejection were significantly lower than that of CsA-based immunosuppression group [(265.5 ±147.9) μmol/L, (245.8±88.9) μmol/L vs (428.5±119.3) μmol/L, (441.2±125.3) μmol/L, P<0.01, respectively]. Conclusion Conversion to FK506 therapy can significantly reduce recurrent rejection episode, and decreasing serum uric acid level provides long-term benefits to graft survival.
