中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2010年
5期
284-286
,共3页
肾移植%环孢菌素%撤药%危险性评估%治疗结果
腎移植%環孢菌素%撤藥%危險性評估%治療結果
신이식%배포균소%철약%위험성평고%치료결과
Kidney transplantation%Cyclosporine%Drug withdrawal%Risk assessment%Treatment outcome
目的 探讨肾移植受者停用环孢素A(CsA)的安全性、可行性以及停用时机.方法 肾移植术后采用CsA+吗替麦考酚酯(MMF)+泼尼松(Pred)预防排斥反应者38例,术后随访时间都超过2年,18例肾功能稳定正常,无CsA导致的不良反应,经同意后逐渐减少CsA用量,直至停用(主动停药组);20例因血肌酐(SCr)缓慢爬升或CsA不良反应停用CsA(被动停药组).停用CsA后均采用MMF+Pred二联用药,观察各组急性排斥反应发生率、SCr和尿微量蛋白的变化.结果 主动停药组有9例在随访中恢复使用CsA,恢复原因:6例因SCr缓慢上升,1例因发生急性排斥反应,2例因思想顾虑;另外9例一直停用CsA,停用前SCr平均为76.1μmol/L,停用CsA后6、12、18和24个月SCr分别平均为69.7、73.0、75.3和70.4μmol/L.被动停药组中,因SCr爬升而停用CsA者12例,停用后6、12、24和36个月SCr分别平均为116.0、108.2、113.0和108.0μmol/L,明显低于停药前(P<0.05);因CsA不良反应而停用CsA者8例,停药后均明显好转,且无急性排斥反应发生.结论 术后停用CsA宜选择在SCr出现爬行趋势和(或)出现蛋白尿时;对长期存活,且肾功能稳定正常,未出现CsA不良反应者,还是以小剂量CsA维持治疗较妥.
目的 探討腎移植受者停用環孢素A(CsA)的安全性、可行性以及停用時機.方法 腎移植術後採用CsA+嗎替麥攷酚酯(MMF)+潑尼鬆(Pred)預防排斥反應者38例,術後隨訪時間都超過2年,18例腎功能穩定正常,無CsA導緻的不良反應,經同意後逐漸減少CsA用量,直至停用(主動停藥組);20例因血肌酐(SCr)緩慢爬升或CsA不良反應停用CsA(被動停藥組).停用CsA後均採用MMF+Pred二聯用藥,觀察各組急性排斥反應髮生率、SCr和尿微量蛋白的變化.結果 主動停藥組有9例在隨訪中恢複使用CsA,恢複原因:6例因SCr緩慢上升,1例因髮生急性排斥反應,2例因思想顧慮;另外9例一直停用CsA,停用前SCr平均為76.1μmol/L,停用CsA後6、12、18和24箇月SCr分彆平均為69.7、73.0、75.3和70.4μmol/L.被動停藥組中,因SCr爬升而停用CsA者12例,停用後6、12、24和36箇月SCr分彆平均為116.0、108.2、113.0和108.0μmol/L,明顯低于停藥前(P<0.05);因CsA不良反應而停用CsA者8例,停藥後均明顯好轉,且無急性排斥反應髮生.結論 術後停用CsA宜選擇在SCr齣現爬行趨勢和(或)齣現蛋白尿時;對長期存活,且腎功能穩定正常,未齣現CsA不良反應者,還是以小劑量CsA維持治療較妥.
목적 탐토신이식수자정용배포소A(CsA)적안전성、가행성이급정용시궤.방법 신이식술후채용CsA+마체맥고분지(MMF)+발니송(Pred)예방배척반응자38례,술후수방시간도초과2년,18례신공능은정정상,무CsA도치적불량반응,경동의후축점감소CsA용량,직지정용(주동정약조);20례인혈기항(SCr)완만파승혹CsA불량반응정용CsA(피동정약조).정용CsA후균채용MMF+Pred이련용약,관찰각조급성배척반응발생솔、SCr화뇨미량단백적변화.결과 주동정약조유9례재수방중회복사용CsA,회복원인:6례인SCr완만상승,1례인발생급성배척반응,2례인사상고필;령외9례일직정용CsA,정용전SCr평균위76.1μmol/L,정용CsA후6、12、18화24개월SCr분별평균위69.7、73.0、75.3화70.4μmol/L.피동정약조중,인SCr파승이정용CsA자12례,정용후6、12、24화36개월SCr분별평균위116.0、108.2、113.0화108.0μmol/L,명현저우정약전(P<0.05);인CsA불량반응이정용CsA자8례,정약후균명현호전,차무급성배척반응발생.결론 술후정용CsA의선택재SCr출현파행추세화(혹)출현단백뇨시;대장기존활,차신공능은정정상,미출현CsA불량반응자,환시이소제량CsA유지치료교타.
Objective To discuss the optimal occasions for CsA withdrawal after kidney transplantation. Methods Thirty-eight cases of kidney transplantations in out-clinic were included in this study. CsA was withdrawn in their immunosuppressive regimen owing to different reasons after operation.All patients were followed up at least 2 years after operation, and followed up more than 12 months after CsA withdrawal. All patients were divided to two groups: Group A (18 cases), control group; group B (20cases), the CsA withdrawal owing its side effects. Acute rejection rate, SCr, uromicroprotein and side effects were analyzed in order to find the optimal occasions for CsA withdrawal Results CsA was re-administered in 9 cases (50 0/4) owing to different reasons in Group A. In group B, CsA was withdrawn due to gradually increased Scr and proteinuria in 12 cases, CsA related acute toxidty in 2 cases, hepatic injury in 8 cases and other reasons in 2 cases, After withdrawal of CsA, renal function was improved and hepatic injuries were recovered. Conclusion The suitable opportunity for CsA withdrawal for long-term survival patients should be at the beginning of gradually increased Scr and/or proteinuria. For the patients with normal and stable renal function and having no CsA related side effects, small dosage (1.5-2. 0 mg/kg)of CsA was the choice for the maintenance therapy.
