CAJ | 학술논문

背景:西罗莫司作为一种低肾毒性的免疫抑制剂越来越多地取代钙调神经抑制剂用于肾脏移植后,但蛋白尿是其最常见的不良反应之一,迄今为止尚无有效的治疗措施,这很大程度上制约了它的广泛使用.目的:观察小剂量环孢素 A 减轻西罗莫司导致的移植肾蛋白尿的效果和安全性.方法:24例采用以西罗莫司为基础的三联免疫抑制方案(西罗莫司+吗替麦考酚酯+皮质激素)出现蛋白尿的肾移植患者,10例加用小剂量环孢素 A(25 mg/d)的四联免疫方案患者(四联组)与14例维持原三联方案的患者(三联组),随访6个月.结果与结论:①四联组 6个月后蛋白尿有显著下降(P <0.01),同时与三联组比较,差异也有显著性意义(P <0.05).②两组肾小球滤过率比较,差异无显著性意义(P=0.10).③三联组3例次泌尿生殖系感染,四联组发生3人6例次感染,其中1例次肺部感染,5例次泌尿生殖系感染.表明小剂量环孢素在不明显增加肾毒性和感染风险的情况下可以显著减少西罗莫司导致的肾移植后蛋白尿.
배경:서라막사작위일충저신독성적면역억제제월래월다지취대개조신경억제제용우신장이식후,단단백뇨시기최상견적불량반응지일,흘금위지상무유효적치료조시,저흔대정도상제약료타적엄범사용.목적:관찰소제량배포소 A 감경서라막사도치적이식신단백뇨적효과화안전성.방법:24례채용이서라막사위기출적삼련면역억제방안(서라막사+마체맥고분지+피질격소)출현단백뇨적신이식환자,10례가용소제량배포소 A(25 mg/d)적사련면역방안환자(사련조)여14례유지원삼련방안적환자(삼련조),수방6개월.결과여결론:①사련조 6개월후단백뇨유현저하강(P <0.01),동시여삼련조비교,차이야유현저성의의(P <0.05).②량조신소구려과솔비교,차이무현저성의의(P=0.10).③삼련조3례차비뇨생식계감염,사련조발생3인6례차감염,기중1례차폐부감염,5례차비뇨생식계감염.표명소제량배포소재불명현증가신독성화감염풍험적정황하가이현저감소서라막사도치적신이식후단백뇨.
BACKGROUND: Sirolimus has been proposed as a non-nephrotoxic alternative to calcineurin inhibitor for prevention of adverse reaction after kidney transplantation, proteinuria is one of the most significant adverse reactions. So far, there is no effective treatment measure, and it limits the use of this molecule. OBJECTIVE: To investigate the efficacy and safety of low-dose cyclosporine A in reducing the sirolimus-associated proteinuria after kidney transplantation. METHODS: This prospective study included 24 kidney transplant recipients who receiving sirolimus based tri-regimens immunosuppressed therapy (sirolimus+mycophenolate mofetil+cotical hormone) and suffering sirolimus-associated proteinuria. Low-dose cyclosporine (25 mg/d) was added to the tri-regimens immunosuppression in 10 recipients (tetra-regimens group), and the other 14 patients maintained the tri-regimens immonusuppression (tri-regimens group). Al the patients were fol owed-up for 6 months. RESULTS AND CONCLUSION: ①After 6 months fol ow-up, the content of proteinuria in the tetra-regimens group was significantly decreased (P < 0.01), and the difference was significant when compared with tri-regimens group (P < 0.05).②There was no significant difference of the glomerular filtration rate between two groups (P=0.10). There were three patients suffering from genitourinary tract infection in tri-regimens group, while three patients in tetra-regimens group suffered from six infectious episodes, one patient suffered from lung infection and five patients suffered from genitourinary tract infection. Low-dose cyclosporine can reduce sirolimus-associated proteinuria after kidney transplantation without serious nephrotoxicity and infectious side effects.