中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (44): 8277-8280.doi: 10.3969/j.issn.1673-8225.2010.44.027

• 器官移植临床实践 clinical practice of organ transplantation • 上一篇    下一篇

他克莫司替代环孢素A肾移植患者35例：1年随访

杨  磊1，郭  娟1，朱明慧2，苗书斋1，曲青山1，郭  凯2   

  1. 郑州人民医院，  1器官移植科，   2检验科，河南省郑州市 450003
  • 出版日期:2010-10-29 发布日期:2010-10-29
  • 作者简介:杨磊★，1969年生，河南省驻马店市，汉族，1992年新乡医学院毕业，硕士，主要从事肾小球肾炎研究。 cynthiagj@163.com

Thirty-five kidney transplant recipients after conversion to tacrolimus from ciclosporin A: A one-year follow-up

Yang Lei1, Guo Juan1, Zhu Ming-hui2, Miao Shu-zhai1, Qu Qing-shan1, Guo Kai2   

  1. 1 Department of Organ Transplantation, 2 Department of Clinical Laboratory, People’s Hospital of Zhengzhou, Zhengzhou  450003, Henan Province, China
  • Online:2010-10-29 Published:2010-10-29
  • About author:Yang Lei★, Master, Department of Organ Transplantation, People’s Hospital of Zhengzhou, Zhengzhou 450003, Henan Province, China cynthiagj@163.com

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摘要：

背景：自环孢素A应用于临床以来，肾移植患者人肾存活率得到了显著的提高，但随后出现的肾毒性、高血压、高血脂等不良反应，增加了排斥反应的发生。
目的：观察以他克莫司替换环孢素A对肾移植患者移植后肾功能、血脂及血压的影响。
方法：选择郑州人民医院接受同种异体肾移植患者35例，其中男21 例，女14 例，平均年龄(38.3 ±22.6)岁。移植后均采用环孢素A、霉酚酸酯及泼尼松三联免疫抑制方案，移植时间 27 (11~53)个月，血清肌酐水平为134.4~232.8 µmol/L。随访1年以上，有12例患者血压持续高于140/90 mm Hg(1 mm Hg=0.133 kPa)，6例患者出现多毛症和牙龈增生，17例有高脂血症。停服环孢素A的同时增加霉酚酸酯剂量至750 mg，2次/d，2 d后加服他克莫司0.10~0.15 mg/kg，随后根据血药浓度调整药物剂量。监测血清肌酐、肾小球滤过率、24 h尿蛋白定量、血脂等生化指标的变化情况，并观察随访期间药物的不良反应。
结果与结论：35例患者中32例完成了1年随访，2例患者重新服用环孢素A，其中1例是因服用他克莫司导致产生的糖尿病，另1例因中度脱发问题而放弃服用他克莫司，1例患者随访丢失。替代治疗1年后，12例患者血压明显改善(P < 0.05)，服用高血压药物已基本能控制；绝大多数患者血脂浓度显著降低，其中7例患者血脂水平已明显正常；6例患者多毛症和牙龈增生现象好转，换药后无新发糖尿病或恶化现象；所有患者肌酐和尿素氮清除率明显改善(P < 0.05)。提示在某些情况下，以他克莫司替换环孢素A可以明显改善心脑血管和肾功能，减轻或消除不良反应。

关键词: 他克莫司, 肾移植, 高血压, 高血脂, 环孢素A

Abstract:

BACKGROUND: Since cyclosporine A has been used in clinical, the survival rate of transplanted kidney have been significantly improved, but renal toxicity, hypertension, hyperlipidemia and other adverse reactions subsequently, increased the incidence of rejection.
OBJECTIVE: To evaluate the effect of Tacrolimus on renal function, blood fat, and blood pressure of patients following renal transplantation.
METHODS: A total of 35 patients with allograft renal transplantation, including 21 males and 14 females, average aging (38.3±22.6) years, were selected from People’s Hospital of Zhengzhou. All received the immunosuppressive regimen of cyclosporine A, mycophenolate mofetil, and prednisone. Transplantation time was 27 (11-53) months, and serum creatinine level was 134.4-232.8 µmol/L. Following one-year following up, blood pressure of 12 patients was up to 140/90 mm Hg (1 mm Hg= 0.133 kPa), 6 patients had hypertrichosis and gingival hyperplasia, and 17 patients had hyperlipoidemia. After stopping taking cyclosporin A, mycophenolate mofetil was adjusted to 750 mg, and administrated twice a day. Two days later, tacrolimus (0.10-0.15 mg/kg) was additionally given. According to serum concentration, the dose was adjusted correspondingly. Serum creatinine (SCr), glomerular filtration rate (GFR), 24-hour urinary protein, blood lipids and other biochemical parameters were monitored, and the adverse drug reactions were observed during the following-up.
RESULTS AND CONCLUSION: A total of 32 out of 35 patients finished the one-year following up. Two patients were given cyclosporine A due to diabetes mellitus and moderate alopecia, and one patient was lost during following up. After 1 year, blood pressure of 12 patients was improved remarkably (P < 0.05), and blood fat level of most patients significantly decreased, including the level of 7 patients was normal. Additionally, hypertrichosis and gingival hyperplasia of 6 patients were improved obviously, and diabetes mellitus or aggravation was not checked out after change of dressing. Serum creatinine (SCr) and urea nitrogen clearance ratio of all patients were significantly improved (P < 0.05). This suggested that tacrolimus remarkably improved cardio-cerebral vessel and renal function, and relieved or eliminated adverse effects.

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