中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2012年
1期
14-17
,共4页
苗芸%于立新%邓文锋%付绍杰%徐健%杜传福%王亦斌%叶桂荣%张新科%周敏捷
苗蕓%于立新%鄧文鋒%付紹傑%徐健%杜傳福%王亦斌%葉桂榮%張新科%週敏捷
묘예%우립신%산문봉%부소걸%서건%두전복%왕역빈%협계영%장신과%주민첩
肾移植%糖尿病%他克莫司%环孢菌素
腎移植%糖尿病%他剋莫司%環孢菌素
신이식%당뇨병%타극막사%배포균소
Kidney transplantation%Diabetes mellitus%Tacrolimus%Cyclosporine
目的 初步探讨环孢素A(CsA)短期替代他克莫司(Tac)对移植后新发糖尿病( NODAT)的改善作用.方法 前瞻性分析19例以Tac为基础免疫抑制剂的NODAT患者的资料.其中7例NODAT诊断明确后将Tac转换为CsA,6个月后再次转换回Tac(转换组)；12例诊断为NODAT后继续应用Tac(对照组).结果 转换组空腹血糖(FPG)由人组时的(8.3±3.9)mmol/L降至转换12个月时的(5.6±1.8)mmol/L(P＜0.01),对照组入组时和12个月时的FPG分别为(8.1±3.5) mmol/L和(8.0±3.0)mmol/L(P＞0.05),组间12个月时相比较,差异有统计学意义(P＜0.05).转换组糖化血红蛋白(HbA1c)由入组时的(6.8±0.8)％降至12个月时的(6.1±0.4)％(P＜0.05),对照组入组时和12个月时的HbA1c分别为(6.9±0.7)％和(6.8±1.5)％(P＞0.05),两组间12个月时相比较,差异有统计学意义(P＜0.05).随访结束时,转换组中4例(57.1％,4/7)NODAT完全缓解,而对照组中无NODAT缓解病例(P＜0.01).转换组血压和血脂水平在转换之后维持稳定.两组间移植物功能以及急性排斥反应发生率的差异无统计学意义(P＞0.05).两组随访结束时移植物和受者存活率均为100％.结论 发生NODAT的肾移植受者将Tac短期(6个月)转换为CsA,可明显改善糖代谢异常.
目的 初步探討環孢素A(CsA)短期替代他剋莫司(Tac)對移植後新髮糖尿病( NODAT)的改善作用.方法 前瞻性分析19例以Tac為基礎免疫抑製劑的NODAT患者的資料.其中7例NODAT診斷明確後將Tac轉換為CsA,6箇月後再次轉換迴Tac(轉換組)；12例診斷為NODAT後繼續應用Tac(對照組).結果 轉換組空腹血糖(FPG)由人組時的(8.3±3.9)mmol/L降至轉換12箇月時的(5.6±1.8)mmol/L(P＜0.01),對照組入組時和12箇月時的FPG分彆為(8.1±3.5) mmol/L和(8.0±3.0)mmol/L(P＞0.05),組間12箇月時相比較,差異有統計學意義(P＜0.05).轉換組糖化血紅蛋白(HbA1c)由入組時的(6.8±0.8)％降至12箇月時的(6.1±0.4)％(P＜0.05),對照組入組時和12箇月時的HbA1c分彆為(6.9±0.7)％和(6.8±1.5)％(P＞0.05),兩組間12箇月時相比較,差異有統計學意義(P＜0.05).隨訪結束時,轉換組中4例(57.1％,4/7)NODAT完全緩解,而對照組中無NODAT緩解病例(P＜0.01).轉換組血壓和血脂水平在轉換之後維持穩定.兩組間移植物功能以及急性排斥反應髮生率的差異無統計學意義(P＞0.05).兩組隨訪結束時移植物和受者存活率均為100％.結論 髮生NODAT的腎移植受者將Tac短期(6箇月)轉換為CsA,可明顯改善糖代謝異常.
목적 초보탐토배포소A(CsA)단기체대타극막사(Tac)대이식후신발당뇨병( NODAT)적개선작용.방법 전첨성분석19례이Tac위기출면역억제제적NODAT환자적자료.기중7례NODAT진단명학후장Tac전환위CsA,6개월후재차전환회Tac(전환조)；12례진단위NODAT후계속응용Tac(대조조).결과 전환조공복혈당(FPG)유인조시적(8.3±3.9)mmol/L강지전환12개월시적(5.6±1.8)mmol/L(P＜0.01),대조조입조시화12개월시적FPG분별위(8.1±3.5) mmol/L화(8.0±3.0)mmol/L(P＞0.05),조간12개월시상비교,차이유통계학의의(P＜0.05).전환조당화혈홍단백(HbA1c)유입조시적(6.8±0.8)％강지12개월시적(6.1±0.4)％(P＜0.05),대조조입조시화12개월시적HbA1c분별위(6.9±0.7)％화(6.8±1.5)％(P＞0.05),량조간12개월시상비교,차이유통계학의의(P＜0.05).수방결속시,전환조중4례(57.1％,4/7)NODAT완전완해,이대조조중무NODAT완해병례(P＜0.01).전환조혈압화혈지수평재전환지후유지은정.량조간이식물공능이급급성배척반응발생솔적차이무통계학의의(P＞0.05).량조수방결속시이식물화수자존활솔균위100％.결론 발생NODAT적신이식수자장Tac단기(6개월)전환위CsA,가명현개선당대사이상.
Objective To investigate the effectiveness and safety of a short term of CsA interval in TAC related new onset diabetes mellitus (NODAT) after renal transplantation.Methods Clinical data of 19 NODAT patients in TAC-based regiment were analyzed. Two groups of patients with NODAT were identified.In 7 patients,TAC was converted to CsA,and 6 months later to TAC again (converted group); in 12 patients,TAC was given continuously (control group).Results In the converted group,FPG was decreased from 8.3 ± 3.9 mmol/L at the time of conversion to 5.6 ± 1.8mmol/L 12 months later (P＜0.01),and in the control group,that was 8.1 ± 3.5 mmol/L and 8.0 ±3.0 mmol/L respectively (P＞0.05).There was a great significant difference between groups (P＜0.05).In the converted group,HbA1c levels were decreased from 6.8％ ± 0.8％ to 6.1％ ± 0.4％ at 12th month (P＜0.05),while in the control group,HbA1c levels were 6.9％ ± 0.7％ to 6.8％ ±1.5％ (P＞0.05).There was also a great significant difference between groups (P＜0.05).After follow-up for 12 months,4 (57.1％) of converted patients no longer had diabetes versus 0％ in the control group (P＜0.01).Blood pressure and lipid levels were stable after conversion.The conversion was safe in terms of graft function and acute rejection episodes.The 1- year patient survival and graft survival rate was 100％. Conclusion This primary study suggests a significant improvement of glucose metabolism after a short term conversion to CsA in renal transplant patients with NODAT
