CAJ | 학술논문

目的探讨慢性移植肾肾病(CAN)患者将免疫抑制方案中钙调磷酸酶抑制剂(CNI)转换为西罗莫司(SRL)的有效性及安全性.方法选取72例经移植肾活检证实发生CAN的受者,其中35例将免疫抑制方案中CNI转换为SRL(SRL组),其余37例继续原CNI方案(CNI组).另取10例因其他原因将CNI转换为SRL治疗的受者,将45例转换为SRL的患者分为A组[血肌酐(SCr)＜120 μmol/L),B组(SCr为120～200 μol/L,且Banff分级为Ⅰ～Ⅱ级),C组(SCr为120～200 μmol/L,且Banff分级在Ⅱ级以上),D组(SCr＞200 μmol/L).随访期为24个月,检测各组随访期内的各临床指标.结果转换治疗前,两组间SCr和肾小球滤过率(eGFR)的差异无统计学意义(P＞0.05)；转换治疗后24个月内,SRL组SCr水平和eGFR较CNI组明显改善(P＜0.05),而CNI组的移植肾功能有逐渐衰退的趋势.SRL组尿蛋白及血脂明显上升(P＜0.05),而CNI组变化不大；SRL组血小板计数较CNI组明显下降(P＜0.05),两组间其他指标的差异无统计学意义(P＞0.05).A组患者各指标在转换治疗前后的变化并不大,B组患者的肾功能及蛋白尿有改善明显,C组和D组患者肾功能有不同程度衰退情况,且蛋白尿加重.结论 SRL转换治疗对于稳定及改善CAN患者的移植肾功能是有效、安全的,CAN早期进行转换(SCr＜200 μmol/L)效果明显.
목적 탐토만성이식신신병(CAN)환자장면역억제방안중개조린산매억제제(CNI)전환위서라막사(SRL)적유효성급안전성.방법 선취72례경이식신활검증실발생CAN적수자,기중35례장면역억제방안중CNI전환위SRL(SRL조),기여37례계속원CNI방안(CNI조).령취10례인기타원인장CNI전환위SRL치료적수자,장45례전환위SRL적환자분위A조[혈기항(SCr)＜120 μmol/L),B조(SCr위120～200 μol/L,차Banff분급위Ⅰ～Ⅱ급),C조(SCr위120～200 μmol/L,차Banff분급재Ⅱ급이상),D조(SCr＞200 μmol/L).수방기위24개월,검측각조수방기내적각림상지표.결과 전환치료전,량조간SCr화신소구려과솔(eGFR)적차이무통계학의의(P＞0.05)；전환치료후24개월내,SRL조SCr수평화eGFR교CNI조명현개선(P＜0.05),이CNI조적이식신공능유축점쇠퇴적추세.SRL조뇨단백급혈지명현상승(P＜0.05),이CNI조변화불대；SRL조혈소판계수교CNI조명현하강(P＜0.05),량조간기타지표적차이무통계학의의(P＞0.05).A조환자각지표재전환치료전후적변화병불대,B조환자적신공능급단백뇨유개선명현,C조화D조환자신공능유불동정도쇠퇴정황,차단백뇨가중.결론 SRL전환치료대우은정급개선CAN환자적이식신공능시유효、안전적,CAN조기진행전환(SCr＜200 μmol/L)효과명현.
Objective To study the effect and safety of conversion from calcineurin inhibitors to rapamycin in kidney transplantation recipients with chronic allograft nephropathy.Methods In 82 kidney transplant recipients enrolled in this study,72 cases were diagnosed as having chronic allograft nephropathy by biopsy.Recipients (SRL group) were administered with rapamycin after withdrawal of calcineurin inhibitors.The doses of CNI in other recipients (non-SRL group) were not changed.Renal function,proteinuria,blood pressure,blood fat,hepatic function and hemogram were observed for 24 months in each group.Results During the follow-up period,serum creatinine level was dropped significantly in SRL group (P＜0.05),but it was increased in non-SRL group (P＜0.05).SRL group showed increased proteinuria,serum cholesterol and triglycerides (P＜0.05),and reduced Plt (P＜0.05).According to the renal function before conversion,the recipients who were administered rapamycin divided into four groups.In group A (Scr ＜ 120 μmol/L),there was no significant difference in diverse variables before and after conversion.In group B (Scr 120-200 μmol/L and Banff Ⅰ-Ⅱ),renal function was improved,and proteinuria alleviated.In group C (Scr 120-200 μmol/L and Banff ＞ Ⅱ),and group D (Scr ＞200 μmol/L),renal function was damaged to varying degrees and proteinuria was deteriorated.Conclusion It is safe and effective for patients with chronic allograft nephropathy to convert from calcineurin inhibitors to rapamycin.