CAJ | 학술논문

目的探讨西罗莫司(SRL)与减低剂量的环孢素A(CsA)或他克莫司(Tac)联合方案在慢性移植肾肾病(CAN)中的应用.方法 53例无特定病因所致的CAN患者,在原CsA(或Tac)+吗替麦考酚酯(MMF)+泼尼松(Pred)的免疫抑制方案上加用SRL(四联方案),其中CsA(或Tac)和MMF的用量减少25％～50％.治疗12个月,观察受者血肌酐、肾小球滤过率(GFR)、血胆固醇、血甘油三酯、尿蛋白等的改变.结果四联方案治疗前患者血肌酐为(161.51±106.48)μmol/L,治疗后1个月为(138.47±67.74) μmol/L,治疗后6个月为(126.51±56.21)μmol/L,治疗后12个月为(123.43±54.18)μmol/L.与治疗前相比较,治疗6个月和12个月后,差异有统计学意义(P＜0.05,P＜0.01).四联方案治疗前患者GFR为(0.754±0.302) ml/s,治疗后1个月为(0.868±0.358)ml/s,治疗后6个月为(0.952±0.347) ml/s,治疗后12个月为(1.007±0.394) ml/s.治疗6个月和12个月后,患者GFR与治疗前相比较,差异有统计学意义(P＜0.05,P＜0.01).治疗1、6和12个月后,患者血胆固醇和甘油三酯与治疗前相比较,差异均无统计学意义(P＞0.05,P＞0.05).四联方案治疗前患者尿蛋白阳性率为9.4％,治疗后1个月为13.2％,治疗后6个月为22.6％,治疗后12个月为26.4％.治疗12个月后蛋白尿阳性率与治疗前相比较,差异有统计学意义(P＜0.05).结论应用SRL+ CsA(或Tac)+ MMF+ Pred四联方案改善了CAN患者的血肌酐和GFR,但增加了患者蛋白尿的发生率.
목적 탐토서라막사(SRL)여감저제량적배포소A(CsA)혹타극막사(Tac)연합방안재만성이식신신병(CAN)중적응용.방법 53례무특정병인소치적CAN환자,재원CsA(혹Tac)+마체맥고분지(MMF)+발니송(Pred)적면역억제방안상가용SRL(사련방안),기중CsA(혹Tac)화MMF적용량감소25％～50％.치료12개월,관찰수자혈기항、신소구려과솔(GFR)、혈담고순、혈감유삼지、뇨단백등적개변.결과 사련방안치료전환자혈기항위(161.51±106.48)μmol/L,치료후1개월위(138.47±67.74) μmol/L,치료후6개월위(126.51±56.21)μmol/L,치료후12개월위(123.43±54.18)μmol/L.여치료전상비교,치료6개월화12개월후,차이유통계학의의(P＜0.05,P＜0.01).사련방안치료전환자GFR위(0.754±0.302) ml/s,치료후1개월위(0.868±0.358)ml/s,치료후6개월위(0.952±0.347) ml/s,치료후12개월위(1.007±0.394) ml/s.치료6개월화12개월후,환자GFR여치료전상비교,차이유통계학의의(P＜0.05,P＜0.01).치료1、6화12개월후,환자혈담고순화감유삼지여치료전상비교,차이균무통계학의의(P＞0.05,P＞0.05).사련방안치료전환자뇨단백양성솔위9.4％,치료후1개월위13.2％,치료후6개월위22.6％,치료후12개월위26.4％.치료12개월후단백뇨양성솔여치료전상비교,차이유통계학의의(P＜0.05).결론 응용SRL+ CsA(혹Tac)+ MMF+ Pred사련방안개선료CAN환자적혈기항화GFR,단증가료환자단백뇨적발생솔.
Objective To investigate the efficacy of rapamycin combined with CsA/Tacrolimus (Tac) in chronic allograft nephropathy (CAN).Methods Fifty-three cases of CAN accepted the quadruple immunosuppressive drug program,which contained rapamycin combined with CsA/Tac and MMF and prednisone,and CsA/Tac and MMF were reduced to the original amount of 25％ to 50％.After treatment for 12 months,more relevant indicators,including serum creatinine,glomerular filtration rate,serum cholesterol,triglycerides,urinary protein,GPT and bilirubin and other changes were observed.Results In the patients receiving quadruple regimen of rapamycin during 12 months,the blood Ccr was decreased from (161.51 ± 106.48)μmol/L before treatment to (126.51 ± 56.2)μmol/L after treatment for 6 months (P＜0.05) and to (123.43 ± 54.18)μmol/L after for 12 months (P＜0.01).The GFR was increased from (0.754 ± 0.302) ml/s before treatment to (0.952 ± 0.347)ml/s after treatment for 6 months (P＜0.05) and to (1.007 ± 0.394) ml/s after treatment for 12 months (P＜0.01).Cholesterol and triglycerides in patients had no significant change before and after treatment.The positive rate of proteinuria after treatment showed an increasing trend from 9.4％ before treatment to 26.4％ after treatment for 12 months.Conclusion The quadruple program of rapamycin combined with CsA/FK506 and MMF can significantly improve Ccr and GFR in patients with CAN,but it can increase the incidence of proteinuria in patients: