肾移植三联免疫抑制剂应用合适剂量的探讨  

Dose optimization of triple immunosuppressive therapy in renal transplantation

作　　者：潘晓鸣[1] 薛武军[1] 田普训[1] 丁小明[1] 燕航[1] 冯新顺[1] 项和立[1] 侯军[1] 丁晨光[1] 李杨[1] 

机构地区：[1]西安交通大学医学院第一附属医院肾病中心,陕西西安710061

出　　处：《实用器官移植电子杂志》2013年第3期147-151,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家重点基础研究发展计划(973)项目(2009CB522407);国家自然科学基金(81100179)

摘　　要：目的探讨肾移植术后三联免疫抑制剂应用的合适剂量。方法比较常规剂量组(145例)和低剂量组(128例)肾移植术后患者三联免疫抑制剂用量和急性排斥反应、肺部感染发生率和人/移植肾生存率。结果环孢素A(CsA)和吗替麦考酚酯(MMF)用量在术后6个月内常规剂量组明显高于低剂量组。常规剂量组在6个月内包括活检证实和临床推断,其总的急性排斥发生率为16.5%,而低剂量组为18.7%,两组间差异无统计学意义(P>0.05)。两组患者在6个月内肺部感染发生率分别为30.4%和10.2%(P<0.01),尤其是重症肺部感染发生率常规剂量组明显要高(22.1%比4.7%,P<0.01)。常规剂量组和低剂量组患者人/肾1年生存率分别为89.7%/86.9%和98.4%/96.9%(P<0.01)。排除感染所致的带功死亡后两组患者人/肾1年生存率差异无统计学意义。结论低剂量三联免疫抑制剂应用并不增加急性排斥率、亚临床排斥发生率、排斥治疗逆转率和排斥反应的严重程度,但明显降低肺部感染发生率和病死率。Objective To optimize triple immunosuppressive dose in renal transplantation. Methods According to the dose of triple combined immunosuppressive regimen,200 patients were divided into conventional dose group(n=145)and low-dose group(n=128). The dose of immunosuppressive regimen at two,four weeks, two,three and six months post-transplantation,the incidences of acute rejection,pulmonary infection and patient/graft survival rate were compared respectively between the two groups. Results The dose of triple immunosuppressive agents in the low-dose group was significantly lower than that in conventional dose group at six months post-transplantation. During the first six months post-transplantation,acute rejection including biopsy-proven and clinical presumed acute rejection occurred in 24 of 145 patients(16.5%)in the conventional dose group,and in 24 of 128 patients(18.7%)in the low-dose group(P>0.05). At six months post-transplantation,pulmonary infection, especially severe pulmonary infection,had a significantly higher occurrence in the conventional dose than in the low-dose group(30.4%vs 10.2%and 22.1%vs 4.7%respectively,both P<0.01). At 12 months,patient survival rate was 89.7% and 98.4%(P<0.01),while the graft survival rate was 86.9% and 96.9%(P<0.01)in the conventional dose group and low-dose group respectively. Excluding the death caused by infection with normal renal function,no significant difference was noted between the two groups(P>0.05). Conclusion The low-dose combination of triple immunosuppressive agents post-transplantation can significantly reduce the pulmonary infection and mortality without increasing the incidence and severity of acute rejection and subclinical rejection.

关 键 词：肾移植 免疫抑制 排斥 

分 类 号：R699[医药卫生—泌尿科学]