新型免疫抑制剂SRL在器官移植受者中的转换治疗评价  

Evaluation of Conversion Treatment with SRL in Organ Transplant Recipients

作　　者：顾坚未[1] 王祥慧[1] 徐达[1] 周佩军[1] 施国海[1] 尧凯[1] 

机构地区：[1]上海交通大学医学院瑞金医院器官移植中心,上海200025

出　　处：《上海交通大学学报（医学版）》2006年第6期675-679,共5页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的 评价以钙调磷酸酶抑制剂（CNI）为主要免疫抑制剂的器官移植受者合并危险因素时，应用新型免疫抑制剂西罗莫司（SRL）转换治疗的临床效果及其安全性。方法 对符合入组标准，应用CNI为主要免疫移植剂的75例器官移植受者，进行以SRL为主要免疫抑制剂的转换治疗，CNI在2周内迅速撤除。SRL转换治疗的目标血药浓度为4～8ng／mL，随访观察其临床效果、并发症和不良反应。结果 SRL转换时距移植后时间平均为（13．2±10．7）月，平均随访时间（9．5±6．8）月。SRL转换后1月和6月的血药浓度分别平均为（6．2±1．7）ng／mL和（4．3±0．9）ng／mL。SRL转换治疗后6月内发生急性排斥3例（4．0％），安全撤除皮质激素4例，2例急性难治性移植肾排斥逆转，肺部感染6例（8．0％）；血清肌酐转换时为（187．3±71．7）Ixmol／L，转换后6月下降至（137．6±30．3）μmol／L（P＜0．01）；SRL转换后肝功能恢复正常15例，改善2例；血糖恢复正常6例，改善1例；4例恶性肿瘤SRL转换后随访6～13月，2例稳定，2例肿瘤复发。SRL主要不良反应表现为高脂血症。结论 应用CNI为主要免疫抑制剂的器官移植受者出现一种或多种危险因素时，新型免疫抑制剂SRL提供了较好的治疗选择。Objective To evaluate the efficacy and safety of converting calcineurin inhibitor （CNI） to sirolimus （SRL） in organ transplant recipients with risk factors. Methods Seventy-five eligible organ transplant patients treated with CNI as main immunosuppressant were converted to SRL immunosuppressant protocol with fast CNI withdrawal in 2 weeks. SRL was titrated to target trough levels of 4～8 ng/mL. The clinical outcomes,complications and side effects were observed. Results The conversion was performed （ 13.2 ± 10.7 ） months after transplantation with a follow-up of （9.5 ± 6.8） months. SRL target trough levels were （6.2 ± 1.7 ） ng/mL （ first month） and （4.3 ± 0.9） ng/mL（sixth month）. Three patients （4.0%） experienced acute rejection. Two patients with acute refractory rejection were reversed successfully. Six patients（8.0% ） were complicated with pulmonary infection within 6 months after SRL conversion. Serum creatinine dropped from （ 187.3 ± 71.7 ） μmol/L （ at conversion） to （ 137.6 ± 30.3 ） μmol/L （6 months after conversion） （ P 〈 0.01 ）. CNI-related hepatotoxicity （ n = 17 ） and hyperglycemia （ n = 7 ） were improved after SRL treatment. Two of 4 patients with malignant tumor （follow-up for 6 to 13 months） were stable and the rest recurred. The main side effects of SRL were hyperlipemia. Conclusion The conversion treatment with SRL may be a better option for organ transplant recipients with CNI and risk factors.

关 键 词：钙调磷酸酶抑制剂 西罗莫司 器官移植 转换治疗 

分 类 号：R617[医药卫生—外科学] R392.4[医药卫生—临床医学]