肾移植后不同时期转换为吗替麦考酚酯长期治疗的疗效观察
신이식후불동시기전환위마체맥고분지장기치료적료효관찰
Clinical outcomes in renal allograft recipients switched to long-term immunosuppressive therapy with mycophenolate mofetil after renal transplantation
  • 万方数据
    中华器官移植杂志 중화기관이식잡지
    CHINESE JOURNAL OF ORGAN TRANSPLANTATION
    2012年 12期 716-720 ,共5页

    陈立中%刘志红%石炳毅%陈江华%凌建煜%张炜%张艮甫%敖建华%卢一平%张小东%范昱%田野%马潞林%王立明%杨顺良%薛武军%明长生%朱同玉%徐达%李香铁

    진립중%류지홍%석병의%진강화%릉건욱%장위%장간보%오건화%로일평%장소동%범욱%전야%마로림%왕립명%양순량%설무군%명장생%주동옥%서체%리향철

    吗替麦考酚酯%肾移植%钙调磷酸酶抑制剂%肾小球滤过率 嗎替麥攷酚酯%腎移植%鈣調燐痠酶抑製劑%腎小毬濾過率
    마체맥고분지%신이식%개조린산매억제제%신소구려과솔
    Mycophenolate mofetil%Kidney transplantation%Calcineurin%Glomerular Filtration Rate
    目的 观察并评价肾移植后不同时期转换为吗替麦考酚酯(MMF)对受者肾功能的影响.方法 多中心、非干预性观察研究,463例分为2组:Switch组(340例),肾移植6个月后转换为MMF治疗,转换起随访4年；Stay组(123例),肾移植后一直应用MMF治疗,入组后随访4年.2组内各分为4个亚群:A群,移植后6个月至1年转换(或入组)；B群,移植后1-2年转换(或入组)；C群,移植后2-5年转换(或入组)；D群,移植5年后转换(或入组).结果 Switch组转换后受者的肾小球滤过率(GFR)明显改善,其斜率改变为3-1 ml· min-1·年-1(P＜0.01)；Stay组入组前后的GFR则保持稳定(P＞0.05).Switch组各亚群间肾功能下降发生时间的差异有统计学意义(P＜0.01),B群最晚,D群最早；Stay组各亚群间的差异无统计学意义(P＞0.05).Stay组肾功能正常者的比例每年均高出Switch组12％或以上.结论 肾移植6个月后至数年转换为MMF治疗,均可显著改善受者的肾功能,越早转换越有利于肾功能的改善.移植后即持续MMF治疗有利于维持受者肾功能的稳定.
    목적 관찰병평개신이식후불동시기전환위마체맥고분지(MMF)대수자신공능적영향.방법 다중심、비간예성관찰연구,463례분위2조:Switch조(340례),신이식6개월후전환위MMF치료,전환기수방4년；Stay조(123례),신이식후일직응용MMF치료,입조후수방4년.2조내각분위4개아군:A군,이식후6개월지1년전환(혹입조)；B군,이식후1-2년전환(혹입조)；C군,이식후2-5년전환(혹입조)；D군,이식5년후전환(혹입조).결과 Switch조전환후수자적신소구려과솔(GFR)명현개선,기사솔개변위3-1 ml· min-1·년-1(P＜0.01)；Stay조입조전후적GFR칙보지은정(P＞0.05).Switch조각아군간신공능하강발생시간적차이유통계학의의(P＜0.01),B군최만,D군최조；Stay조각아군간적차이무통계학의의(P＞0.05).Stay조신공능정상자적비례매년균고출Switch조12％혹이상.결론 신이식6개월후지수년전환위MMF치료,균가현저개선수자적신공능,월조전환월유리우신공능적개선.이식후즉지속MMF치료유리우유지수자신공능적은정.
    Objective To document the impact of conversion to mycophenolate mofetil (MMF)at different time points after transplantation on the renal function of renal function.Methods A longterm,multicenter,non-interventional and observational study was done.Two cohorts were included:One was Switch cohort (340 cases) including renal allograft recipients who switched to MMF at least 6 months after renal transplantation and followed up for 4 years after switch; The other was Stay cohort (123 cases),including renal allograft recipients who received MMF treatment after transplantation and followed up for 4 years after enrollment.Results GFR values of patients in Switch cohort was significantly increased after switch,and the change in GFR slope was 3.1 mL· min-1 · year-1 (P＜0.01).GFR values of patients in Stay cohort kept steady before and after enrollment,and the change in GFR slope was 0.44 mL·min-1 ·year-1 (P＞0.05).Statistically significant difference in the onset time of GFR decline (defined as 20％ decline from the baseline) was observed among subgroups within Switch cohort (P＜0.01),but there was no significant difference among subgroups within Stay cohort (P＞0.05).Stay cohort was 12％ higher than in Switch cohort every year.Conclusion Conversion to MMF ＞6 months or even many years after transplantation can obviously improve the renal function of recipients.The earlier conversion can benefit improvement of the renal function.
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