中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (40): 7426-7432.doi: 10.3969/j.issn.2095-4344.2012.40.004

• 肾移植 kidney transplantation • 上一篇    下一篇

环孢素治疗丙型肝炎病毒RNA阳性肾移植患者的抗病毒复制效应

刘铁石，李笑弓，赵晓智，刘光香，郭宏骞   

  1. 南京大学医学院附属南京鼓楼医院泌尿外科，江苏省南京市 210008
  • 收稿日期:2012-07-02 修回日期:2012-07-19 出版日期:2012-09-30 发布日期:2012-09-30
  • 通讯作者: 郭宏骞，博士，博士生导师，南京大学医学院附属南京鼓楼医院泌尿外科，江苏省南京市 210008
  • 作者简介:刘铁石，男，1975年生，吉林省吉林市人，汉族，白求恩医科大学毕业，主治医师，主要从事肾移植及泌尿系统肿瘤相关工作。

Anti-virus efficacy of cyclosporine in renal transplant recipients with hepatitis C virus-RNA positive

Liu Tie-shi, Li Xiao-gong, Zhao Xiao-zhi, Liu Guang-xiang, Guo Hong-qian   

  1. Department of Urology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
  • Received:2012-07-02 Revised:2012-07-19 Online:2012-09-30 Published:2012-09-30
  • Contact: Guo Hong-qian, Doctor, Doctoral supervisor, Department of Urology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China dr.ghq@163.com
  • About author:Liu Tie-shi, Attending physician, Department of Urology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China liutieshi@163.com

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被引次数

2

摘要：

背景：丙型肝炎病毒阳性患者接受肾脏移植后，免疫抑制剂的选择及抗丙型肝炎病毒药物的选用是目前关注的重点。
目的：探讨环孢素在丙型肝炎病毒RNA阳性肾移植患者中除抗排斥作用以外的抗病毒复制作用。
方法：纳入11例丙型肝炎病毒RNA阳性肾移植患者，于采用环孢素+咪唑立宾+泼
尼松治疗方案时记为入组，分别对入组前、入组后6，12个月时患者丙型肝炎病毒RNA、血红蛋白、肝肾功能等指标的变化进行检测。
结果与结论：入组前、入组6个月、入组12个月11例患者丙型肝炎病毒RNA中位数(copies/mL)分别为1.22×107，1.11×104，4.19×106；入组6个月时，有8例患者丙型肝炎病毒RNA转阴(丙型肝炎病毒RNA<500 copies/mL)，总应答率为73%(8/11)；至随访结束，持续病毒学应答率为55%(6/11)。且入组治疗前后患者谷丙转氨酶、血清肌酐、血尿酸水平差异均无显著性意义(P > 0.05)，患者血红蛋白水平在入组后升高。随访过程中，仅1例发生排斥反应，甲基强的松龙冲击治疗 3 d后好转。提示对于合并丙型肝炎的肾移植患者，选用环孢素为主的治疗方案，在达到抗排斥治疗作用的同时，可发挥抑制丙型肝炎病毒复制的作用。

关键词: 肾移植, 并发症, 丙型肝炎, 丙型肝炎病毒, 免疫抑制剂, 环孢素, 抗病毒, 器官移植

Abstract:

BACKGROUND: The selection of immunosuppressants and anti-hepatitis C virus drug is currently the focus for the hepatitis C virus-positive patients after receiving renal transplantation.
OBJECTIVE: To investigate the anti-virus replication effect of cyclosporine in hepatitis C virus-RNA positive renal transplant recipients in addition to its anti-rejection effect.
METHODS: Eleven hepatitis C virus-RNA positive renal transplant recipients were enrolled and treated with cyclosporine, prednisone and mizoribine. Hepatitis C virus-RNA level, hemoglobin, liver functions and renal functions were evaluated before treatment and at 6 and 12 months after treatment.
RESULTS AND CONCLUSION: The median of hepatitis C virus-RNA in 11 patients before treatment, and at 6 and 12 months after treatment were 1.22×107 copies/mL, 1.11×104 copies/mL and 4.19×106 copies/mL respectively. At 6 months after treatment, 8 cases of hepatitis C virus-RNA were negative (hepatitis C virus-RNA < 500 copies/mL), and the total response of hepatitis C virus-RNA was 73%, and the sustained virological response was 55% (6/11) at the final follow-up. There was no significant difference of alanine transaminase, serum creatinine and serum uric acid levels before and after treatment (P > 0.05), and the hemoglobin level was increased after treatment. During the follow-up, acute rejection only occurred in one patient and was controlled within 3 days after methylprednisolone pulse therapy. Cyclosporine-based treatment would be a better choice for renal transplant recipients combined with hepatitis C virus infection for both the anti-virus replication and anti-rejection effect.

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