中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (5): 801-804.doi: 10.3969/j.issn.1673-8225.2012.05.010

• 肾移植 kidney transplantation • 上一篇    下一篇

他克莫司替换环孢素A联合雷公藤多甙片治疗慢性移植肾肾病★

张建强，魏亚非，胡建敏，陈  桦，李留洋，李  民，赵  明   

  1. 南方医科大学珠江医院，广东省广州市  510282
  • 收稿日期:2011-08-16 修回日期:2011-12-22 出版日期:2012-01-29 发布日期:2012-01-29
  • 通讯作者: 赵明，博士，主任医师，博士生导师，南方医科大学珠江医院，广东省广州市 510282
  • 作者简介:张建强★，男，1986年生，江西省上饶市余干县人，汉族，在读硕士，医师，主要从事移植免疫临床及基础方面研究。 jianqiang0626@163.com

nversion from cyclosporin A to tacrolimus combined with Tripterygium wilfordii Hook. f. for the treatment of chronic allograft nephropathyCo

Zhang Jian-qiang, Wei Ya-fei, Hu Jian-min, Chen Hua, Li Liu-yang, Li Min, Zhao Ming   

  1. Zhujiang Hospital of Southern Medical University, Guangzhou  510280, Guangdong Province, China
  • Received:2011-08-16 Revised:2011-12-22 Online:2012-01-29 Published:2012-01-29
  • Contact: Zhao Ming, Doctor, Chief physician, Doctoral supervisor, Zhujiang Hospital of Southern Medical University, Guangzhou 510280, Guangdong Province, China
  • About author:Zhang Jian-qiang★, Studying for master’s degree, Physician, Zhujiang Hospital of Southern Medical University, Guangzhou 510280, Guangdong Province, China jianqiang0626@163.com

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摘要：

背景：近年来，多项研究表明环孢素A转换成他克莫司的免疫抑制方案对慢性移植肾肾病有一定疗效。
目的：探讨他克莫司替换环孢素A联合雷公藤多甙片治疗慢性移植肾肾病的疗效及安全性。
方法：回顾性分析经临床及病理证实为慢性移植肾肾病的患者57例，诊断前均采用环孢素A+吗替麦考酚酯+泼尼松免疫抑制治疗，然后根据不同的治疗方案分成两组：环孢素A组(n=27)，继续采用原方案治疗；他克莫司+雷公藤多甙片组(n=30)，环孢素A切换成他克莫司的同时再联用雷公藤多甙片治疗。
结果与结论：转换后3，6个月两组间血肌酐、24 h尿蛋白水平比较差异均有显著性意义(P < 0.05)，各组3个月与6个月的血肌酐、24 h尿蛋白水平比较差异均无显著性意义(P > 0.05)，血总胆固醇、三酰甘油、丙氨酸氨基转换酶、天冬酸氨基转换酶等指标两组间差异无显著性意义(P > 0.05)。他克莫司+雷公藤多甙片组震颤发生率较环孢素A组高(P < 0.05)，但高血压、多毛症、血糖升高、牙龈增生的发生率显著低于环孢素A组(P < 0.05)。结果表明他克莫司替换环孢素A联合雷公藤多甙片的治疗方案对慢性移植肾肾病有显著的疗效，且安全性能好，有助于移植肾的长期存活。

关键词: 他克莫司, 环孢素A, 雷公藤多甙片, 慢性移植肾肾病, 肾移植

Abstract:

BACKGROUND: In recent years, several studies have shown that immunosuppressive regimen of tacrolimus conversed from cyclosporine A (CsA) has a certain effect on chronic allograft nephropathy. 
OBJECTIVE: To investigate the clinical efficacy and safety of conversion from CsA to tacrolimus combined with Tripterygium wilfordii Hook. f. (TII) on CAN.
METHODS: Retrospectively analysis of 57 patients with chronic allograft nephropathy diagnosed by clinical and pathological identification. The patients were treated with CsA+mycophenolate mofetil+prednisone immunosuppressive therapy before diagnosis, and then the patients were divided into two groups according to different treatment options: CsA group (n=27) which was continued to use the initial therapy, CsA+TII group (n=30) was treated by tacrolimus instead of CsA combined with TII.
RESULTS AND CONCLUSION: There was significant difference on the level of serum creatinine and quantity of 24-hour urine protein excretion in two groups at 3 and 6 months after conversion (P < 0.05), but there were no statistical difference of those in each group at 3 and 6 months (P > 0.05). And there were no significant differences on the level of total cholesterol, triacylglycerol, alanine aminotransferase and aspartic acid aminotransferase between two groups (P > 0.05). The tremor incidence in CsA+TII group was obviously higher than that in the CsA group (P < 0.05), but the incidence of hypertension, hypertrichosis, hyperglycemia and gingival overgrowth in CsA+TII group was significantly lower than that in the CsA group (P < 0.05). Conversion from CsA to tacrolimus combined with TII has a good efficacy for the treatment of chronic allograft nephropathy in kidney transplant recipients with fewer adverse effects, which benefits for the long-term survival of allograft.

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