南方医科大学学报
南方醫科大學學報
남방의과대학학보
JOURNAL OF SOUTHERN MEDICAL UNIVERSITY
2014年
5期
690-693
,共4页
余意%聂海波%王尉%胡卫列%吕军
餘意%聶海波%王尉%鬍衛列%呂軍
여의%섭해파%왕위%호위렬%려군
西罗莫司%肾移植术后糖尿病%钙调磷酸蛋白酶抑制剂%转换治疗%他克莫司
西囉莫司%腎移植術後糖尿病%鈣調燐痠蛋白酶抑製劑%轉換治療%他剋莫司
서라막사%신이식술후당뇨병%개조린산단백매억제제%전환치료%타극막사
sirolimus%new-onset diabetes mellitus after transplantation%calcineurin inhibitors%conversion therapy%tacrolimus
目的：评价西罗莫司（SRL）转换钙调磷酸蛋白酶抑制剂（CNI）治疗肾移植术后糖尿病的安全性及疗效。方法回顾性分析我院近10年321例肾移植术后患者，其中有34例（10.59%）诊断为肾移植术后糖尿病，按治疗方案分为3组：A组（14例）为标准化的CNI减量方案，B组（12例）为SRL转换CNI药物方案，C组（10例）为口服降糖药物，所有患者均辅助饮食及运动疗法。当餐后血糖超过14.0 mmol/L时，餐前均辅助皮下注射短效胰岛素治疗并维持治疗，并规律随访5年。结果所有入组患者诊断肾移植术后糖尿病时血糖平均13.02±1.74 mol/L，3组间无显著性差异（P>0.05）。经辅助治疗6月后，A、B、C组患者血糖分别平均下降至8.05±2.45、7.45±2.44和9.30±3.89 mmol/L。经调整胰岛素剂量12月后A组和B组患者血糖均降至正常，但日均胰岛素用量，A组患者明显多于B组（P<0.05）。SRL组转换时的肌酐165.1±61.8 mmol/L，转换5年后肌酐150.0±53.0 mmol/L（P<0.05）；CNI减量组治疗前肌酐152.0±43.0 mmol/L，5年后肌酐是145.9±53.0 mmol/L；C组患者肾功能没有在治疗中获益，治疗后肌酐上升。A组患者5年生存率人/肾分别是100%和75%，与B组患者人/肾生存率83.4%和68%，两组无显著性差异（P>0.05），C组患者5年生存率分别是71.8%和52.4%，明显低于A组和B组。结论肾移植术后行SRL转换CNI药物有利于改善肾移植术后糖尿病且不增加排斥风险。
目的：評價西囉莫司（SRL）轉換鈣調燐痠蛋白酶抑製劑（CNI）治療腎移植術後糖尿病的安全性及療效。方法迴顧性分析我院近10年321例腎移植術後患者，其中有34例（10.59%）診斷為腎移植術後糖尿病，按治療方案分為3組：A組（14例）為標準化的CNI減量方案，B組（12例）為SRL轉換CNI藥物方案，C組（10例）為口服降糖藥物，所有患者均輔助飲食及運動療法。噹餐後血糖超過14.0 mmol/L時，餐前均輔助皮下註射短效胰島素治療併維持治療，併規律隨訪5年。結果所有入組患者診斷腎移植術後糖尿病時血糖平均13.02±1.74 mol/L，3組間無顯著性差異（P>0.05）。經輔助治療6月後，A、B、C組患者血糖分彆平均下降至8.05±2.45、7.45±2.44和9.30±3.89 mmol/L。經調整胰島素劑量12月後A組和B組患者血糖均降至正常，但日均胰島素用量，A組患者明顯多于B組（P<0.05）。SRL組轉換時的肌酐165.1±61.8 mmol/L，轉換5年後肌酐150.0±53.0 mmol/L（P<0.05）；CNI減量組治療前肌酐152.0±43.0 mmol/L，5年後肌酐是145.9±53.0 mmol/L；C組患者腎功能沒有在治療中穫益，治療後肌酐上升。A組患者5年生存率人/腎分彆是100%和75%，與B組患者人/腎生存率83.4%和68%，兩組無顯著性差異（P>0.05），C組患者5年生存率分彆是71.8%和52.4%，明顯低于A組和B組。結論腎移植術後行SRL轉換CNI藥物有利于改善腎移植術後糖尿病且不增加排斥風險。
목적：평개서라막사（SRL）전환개조린산단백매억제제（CNI）치료신이식술후당뇨병적안전성급료효。방법회고성분석아원근10년321례신이식술후환자，기중유34례（10.59%）진단위신이식술후당뇨병，안치료방안분위3조：A조（14례）위표준화적CNI감량방안，B조（12례）위SRL전환CNI약물방안，C조（10례）위구복강당약물，소유환자균보조음식급운동요법。당찬후혈당초과14.0 mmol/L시，찬전균보조피하주사단효이도소치료병유지치료，병규률수방5년。결과소유입조환자진단신이식술후당뇨병시혈당평균13.02±1.74 mol/L，3조간무현저성차이（P>0.05）。경보조치료6월후，A、B、C조환자혈당분별평균하강지8.05±2.45、7.45±2.44화9.30±3.89 mmol/L。경조정이도소제량12월후A조화B조환자혈당균강지정상，단일균이도소용량，A조환자명현다우B조（P<0.05）。SRL조전환시적기항165.1±61.8 mmol/L，전환5년후기항150.0±53.0 mmol/L（P<0.05）；CNI감량조치료전기항152.0±43.0 mmol/L，5년후기항시145.9±53.0 mmol/L；C조환자신공능몰유재치료중획익，치료후기항상승。A조환자5년생존솔인/신분별시100%화75%，여B조환자인/신생존솔83.4%화68%，량조무현저성차이（P>0.05），C조환자5년생존솔분별시71.8%화52.4%，명현저우A조화B조。결론신이식술후행SRL전환CNI약물유리우개선신이식술후당뇨병차불증가배척풍험。
Objective To evaluate safety and efficacy of conversion of calcineurin inhibitors (CNI) to sirolimus (SRL) therapy for treatment of new-onset diabetes after kidney transplantation (NODAT). Methods Of 321 kidney transplant recipients, 34 patients who developed NODAT (10.59%) were divided into 3 groups to receive continued CNI therapy at a reduced dose (group A, 14 cases), sirolimus conversion therapy (group B, 12 cases), or oral hypoglycemic drugs (group C, 12 cases). All the patients had dietary and exercise therapies, and insulin injections were given in patients with postprandial (2 h) blood glucose over 14.0 mmol/L. The patients were followed up regularly for 5 years. Results The mean blood glucose level was 13.02 ± 1.74 mol/L upon the diagnosis of NODAT in the 34 patients without significant differences between the 3 groups. At 6 months of therapy, fasting plasma glucose levels in the 3 groups decreased to 8.05±2.45, 7.45±2.44, and 9.30±3.89 mmol/L, repsrectively;at 12 months, blood glucose became normal in both groups A and B, but the patients in group A needed a greater daily insulin dose (P<0.05). In group B, the mean serum creatinine level was 165.1±61.82 mmol/L at the conversion and lowered to 150±53.05 mmol/L at 5 years (P<0.05), which were similar to those in group A at the two time points (152±43.05 and 145.88±53.05 mmol/L, respectively;P>0.05). In group C, creatinine level further increased after medication with oral hypoglycemic drugs. At 5 years, the patient and graft survival rates were 100%and 75%in group A, respectively, similar to those in group B (83.4%and 68%, respectively; P>0.05); group C showed lower patient and graft survival rates than groups B and C. Conclusion Conversion from CNI to SLR therapy can significantly the metabolism of patients with NODAT without increasing the risk of acute graft rejection.
