雷帕霉素对肾移植受者血脂的影响  

Effect of rapamycin on serum lipids in patients with renal transplantation

作　　者：王长希[1] 尚文俊[1] 陈立中[1] 费继光[1] 邱江[1] 郑克立[1] 

机构地区：[1]中山大学附属第一医院移植科,广州510080

出　　处：《肾脏病与透析肾移植杂志》2004年第3期222-225,共4页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的 :探讨雷帕霉素 (rapamycin ,RPM)对肾移植受者血脂的影响。　 方法 :收集 2 0 0 1年 3月至 2 0 0 2年 1 1月我院行首次尸体肾移植并开始接受RPM治疗随访至今的 2 3例受者 ,免疫抑制剂治疗方案为RPM联合环孢素 (CsA)和皮质类固醇三联疗法。移植后 4 8h内开始给予RPM治疗 ,首次负荷剂量为 6mg ,维持剂量为 2mg/d ,部分患者在血脂升高后RPM减量至 1～ 1 5mg/d ;定期检测RPM浓度、CsA浓度及各项血脂指标。　 结果 :2 2例患者随访 6～ 1 2个月 ,1例因胃肠道不适中止随访。 1、3、6个月RPM平均浓度分别为 (5 1 2± 1 5 8)ng/ml、(6 83± 2 78)ng/ml、(6 1 1± 2 37)ng/ml;1 2个月内高脂血症发生率为 5 9% (1 3/ 2 2 ) ,RPM浓度与总胆固醇浓度相关系数r =0 383(P <0 0 0 1 ) ,与三酰甘油浓度相关系数r=0 2 8(P <0 0 1 ) ;术后血脂指标变化有一定规律 :胆固醇、HDL C、LDL C、载脂蛋白 (Apo)AI、ApoB的变化趋势相似 :术后第 7天基本与术前持平 ,术后 1个月明显上升 ,2～ 4个月达高峰 ,5～ 6个月开始回落 ,但仍高于术前水平 (P <0 0 5 ) ;三酰甘油呈缓慢上升趋势 ,术后 5～ 6个月达高峰 ,术后 1个月各时间点与术前比较差异均有显著性 (P <0 0 1 )。尽管本组患者血脂升高 。Objective:To study the effects of rapamcin (RPM) on serum lipids in recipients with renal transplantation. Methodology:From March 2001 to November 2002 in our center, twenty three primary renal allograft recipients were enrolled in this study. The immunosuppressive regimen was triple therapy of RPM combining with cyclosporin (CsA) and steroid. A loading dose of 6mg RPM was administered within 48 hours after grafting and maintained at 2mg/d thereafter, and RPM was administered in 4h after CsA administration. RPM dose was adjusted to 1 1 5mg/d in some patients with hyperlipidemia. The RPM concentration, CsA concentration, blood lipid indexes were measured regularly. Results:Twenty two patients completed more than 6 months of RPM treating course, and only one discontinued because of adverse event. The average tough RPM concentration at the first, third, and 6th month were (5 12±1 58)ng/ml, (6 83±2 78)ng/ml, and (6 11±2 37)ng/ml. Hyperlipidemia was observed in 59% (13/22) patients during the first 12 posttransplantation month. The tough concentration of RPM was significantly correlated with the concentration of total cholesterol ( r =0 383, P <0 001) and triglyceride ( r =0 28, P <0 01). There was a regular change in the blood lipid indexes curve. Total cholesterol, HDL C, LDL C, ApoAⅠ,ApoB had a similar concentration curve. These indexes were comparative with pre operation in 7 days postoperation, and rose obviously in 1 month postoperation. The curve reach its peak in 2-4 months postoperation and began to decrease in 5-6 months postoperation, though these indexes were still higher than pre operation ( P <0 05). The triglyceride concentration curve showed off a smoothly increase and reached its peak in 5-6 months postoperation. In every point after 1 month postoperation, the triglyceriede concentration was higher significantly than that in preoperation ( P <0 01). Although some patients suffered hyperlipidemia, the occurrences of the graft vascular disease and other cardiovascu

关 键 词：雷帕霉素 肾移植 血脂 RPM 胆固醇 并发症 

分 类 号：R699[医药卫生—泌尿科学]