糖尿病合并终末期肾病肾移植术后应用他克莫司与环孢素A的比较  

Clinical comparison of tacrolimus and CsA in end stage renal disease of diabetic renal allograft recipients

作　　者：于立新[1] 单海涛[1] 刘小友[1] 付绍杰[1] 杜传福[1] 马俊杰[1] 徐健[1] 邓文锋[1] 王亦斌[1] 

机构地区：[1]第一军医大学南方医院肾移植科,广州510515

出　　处：《中华器官移植杂志》2005年第6期347-349,共3页Chinese Journal of Organ Transplantation

摘　　要：目的比较应用小剂量、低谷值浓度的他克莫司(FK506)和环孢素A(CsA)对糖尿病合并终末期肾病肾移植患者的疗效和安全性。方法选择因糖尿病合并终末期肾病行尸肾移植的患者共64例,随机分成两组,术后应用小剂量FK506组(33例)和应用CsA组(31例)。术后根据血糖水平调整胰岛素用量。比较两组急性排斥反应发生率、血糖水平、胰岛素用量的变化及对血压、血脂代谢和肝功能的影响。结果FK506组和CsA组1年人/肾存活率分别为96.97%/93.94%和96.77%/90.32%,差异无统计学意义(P>0.05)。FK506组和CsA组急性排斥反应发生率分别为12.12%(4例)和35.48%(11例),差异有统计学意义(P<0.05)。术后1个月内,FK506组和CsA组胰岛素平均用量分别为(34.35±12.14)U/d和(28.15±8.33)U/d;术后1年,FK506组和CsA组胰岛素平均用量分别为(14.09±4.22)U/d和(13.05±2.17)U/d,两组同期比较,胰岛素用量差异无统计学意义(P>0.05)。FK506组中有21例(63.63%)需要降压治疗,5例(15.15%)需要降血脂治疗,3例(9.09%)出现肝功能损害,需要护肝治疗;CsA组中有28例(90.32%)需要降压治疗,13例(41.94%)需要降血脂治疗,11例(35.48%)出现肝功能损害,需要护肝治疗,差异均有统计学意义(P<0.05)。结论终末期糖尿病肾病肾移植的患者使用小剂量、低谷值浓度的FK506疗效较好,副作用较小;对糖代谢的影响与CsA相近。Objective To compare the efficacy and safety of tacrolimus (FK506)-based versus cyclosporine (CsA)-based immunosuppression in end stage renal disease of diabetic renal allograft recipients. Methods A total of 64 patients were randomized to FK506 ( n =33) or CsA ( n =31) after cadaveric renal transplantation. The small dose low concentration tacrolimus was adapted. The dose of insulin was adjusted according to the level of the blood glucose. The incidence of acute rejection, the level of the glucose, the dose of insulin and the influences on blood pressure, lipid metabolism and liver function were compared and evaluated. Results The 1-year survival rate of recipients/grafts was 96.97 %/ 93.94 % in FK506 group and 96.77 %/ 90.32 % in CsA group. Four patients ( 12.12 %) had acute rejection in the FK506 group, and 11 patients ( 35.48 %) had acute rejection in the CsA group during the first year after the operation. The dose of the insulin in the FK506 group ( 34.35 ± 12.14 )U/d, ( 14.09 ± 4.22 )U/d had no significant difference ( P > 0.05 ) with the CsA group ( 28.15 ± 8.33 )U/d, ( 13.05 ± 2.17 )U/d at the first month and 1 year after the operation. One year after the operation, 21 patients ( 63.63 %) were subjected to anti-hypertensiom, 5 patients ( 15.15 %) to anti-hyperlipidemia treatment and 3 patients ( 9.09 %) to liver protection treatment due to abnormal liver function in FK506 group, while in the CsA group 28 patients ( 90.32 %) were subjected to anti-hypertension, 13 patients ( 41.94 %) to anti-hyperlipidemia treatment and 11 patients ( 35.48 %) to liver protection treatment due to abnormal liver function. There were significant differences between the two groups.Conclusion The small dose low concentration FK506 is effective in the end stage renal disease of diabetic renal allograft recipients and side effect incidence of it was low, and it has almost the same influence on the glucose metabolism as the CsA.

关 键 词：终末期肾病 他克莫司 术后应用 环孢素A FK506 终末期糖尿病肾病 急性排斥反应 降血脂治疗 肝功能损害 谷值浓度 血糖水平 降压治疗 护肝治疗 CsA 肾移植患者 胰岛素 统计学 小剂量 尸肾移植 方法选择 血脂代谢 肾存活率 

分 类 号：R699.2[医药卫生—泌尿科学]