两种不同免疫抑制剂方案对肾移植术后感染及排异的影响  

Effects of two immunosuppressive schemes on post-operative infection and rejection after renal transplantation

作　　者：马强[1] 李黔生[1] 靳凤烁[1] 徐序广[1] 聂志林[1] 靳文生[1] 张勇[1] 霍文谦[1] 李沙丹[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所肾移植中心,重庆400042

出　　处：《西南国防医药》2005年第4期380-383,共4页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的:观察两种不同免疫抑制剂方案对肾移植术后感染及排异的影响.方法:将150例肾移植术后患者分成两组,即2001年以前手术的96例为环孢素(CsA)组,免疫抑制剂为CsA加泼尼松(Pred)加硫唑嘌呤(Aza),CsA初始用量为6～8 mg/(kg*d);2002～2004年1月手术的54例为FK506组,免疫抑制剂为FK506加Pred加骁悉(MMF)FK506初始用量为0.1～0.2 mg/(kg*d),以后根据血药浓度进行调整.结果:150例肾移植术后患者,随访2个月～6年,总的感染率为20.7%,排异率18.1%;其中CsA组感染率为26.0%(25/96),5例死亡,排异逆转率为91.7%(22/24);FK506组感染率为11.1%(6/54),无死亡病例,排异逆转率为100.0%(7/7).两者之间感染率差异有显著意义(P＜0.05).结论:用FK506+MMF代替CsA与Aza可以显著减少肾移植术后的感染率,降低排斥反应,并提高移植肾成活率.Objective： To study the effects of two immunosuppressive schemes on post-operative infection and rejection after renal transplantation. Methods： Before 2001, CsA＋Pred＋Aza were used as the immunosuppressive scheme in 96 cases（CsA group） after renal transplantation. From 2002 to Jan, 2004, the immunosuppressive scheme was changed into FK506＋Pred＋MMF in 54 cases （FK506 group） after renal transplantation. The initial dose of CsA was 6～8 mg/（kg·d） in CsA group and the initial dose of FK506 was 0. 1～0. 2 mg/（kg·d） in FK506 group, and then the dose was regulated according to the plasma levels of drugs. Results： The rates of total infection and rejection in these 150 cases were 20.7% and 18. 1%, respectively, in following-up six years. 25 cases（26. 0%） were infected in CsA group and 6 ones（11.1%） were infected in FK506 group. The rejection reverse rate was 91.7% in CsA group and 100% in FK506 group. There was notable significant difference of infection rate between two groups（P〈0.05）. Conclusion： The post-operative infection and rejection rates in the patients underwent renal transplantation might be reduced evidently when FK506 and MME were used to substitute CsA and Aza in the immunosuppressive scheme for the post-operative management.

关 键 词：肾移植 普乐可复 感染 排异 

分 类 号：R692[医药卫生—泌尿科学]