肾移植受者应用西罗莫司的临床疗效  

Clinical Efficacy of Sirolimus in Renal Allograft Recipients

作　　者：曹志彬[1] 邱丰[1] 刘炜[1] 应亮[1] 凌建煜[1] 

机构地区：[1]上海交通大学医学院仁济医院器官移植中心,上海200127

出　　处：《上海交通大学学报（医学版）》2006年第6期696-698,共3页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的评价肾移植术后应用西罗莫司(SRL)的疗效和安全性。方法60例同种尸体供肾移植患者分为两组。①实验组(n=20):免疫抑制方案为环孢菌素A(CsA)+SRL+强的松(Pred);②对照组(n=40):免疫抑制方案为CsA+霉酚酸酯(MMF)+Pred。随访二组在术后6月内的疗效、并发症及药物不良反应情况,同时监测血脂水平、肝肾功能等生化指标;采用Kap lan-M e ier法分析两种免疫抑制方案对移植肾无急性排斥存活率的影响。结果对照组中1例患者术后3月时因肺部感染死亡,两组其他患者6个月内均带功能存活。除血脂水平外,两组其他实验室指标未出现统计学差异;但两组患者急性排斥发生率、并发症及药物的不良反应明显不同。实验组发生急性排斥2例(10%);移植肾功能延迟恢复1例(5%);肺部感染5例(25.0%);血脂异常11例(55.0%)。对照组中急性排斥8例(20%);移植肾功能延迟1例(2.5%);肺部感染6例(15.0%);血脂异常13例(32.5%);肝功能异常2例(5.0%);腹泻12例(30%),白细胞减少1例。结论肾移植术后应用CsA+SRL+Pred三联免疫抑制治疗方案,会产生更强的免疫抑制效果,其主要副作用是血脂升高。Objective To evaluate the efficacy and safety of sirolimus（SRL） after renal transplantation. Methods Sixty patients were divided into two groups ： experimental group （ n = 20） , cyclosporin A （CsA） ＋ SRL ＋ prednisone （Pred） triple immunosuppressive regimen; control group（ n =40）, CsA ＋ mycophnolate mofetil（MMF） ＋ Pred triple immunosuppressive regimen. Follow-ups were conducted in 6 months after transplantation and the therapeutic efficacy and safety were compared between the two groups. Actuarial graft acute rejection-free survival rate were compared by Kaplan-Meier method. Results One case died from lung infection 3 months after transplantation in the control group, while no other patients died during the 6 months. There was no statistical difference between the two groups in the routine laboratory tests except for dyslipidemia, but there were significant differences in acute rejection, side effects and complications. There were 2 cases of acute rejection （ 10.0% ） , 1 case of delayed graft function （ DGF, 5.0% ） , 5 cases of lung infection（25.0% ） , and 11 cases of dyslipidemia（55% ） in the experimental group. While there were 8 cases of acute rejection （20%） , 1 case of DGF（2.50% ） , 6 cases of lung infection （ 15.0% ） , 13 cases of dyslipidemia（32.5% ）, 2 cases of abnormal liver function（5.0% ）, 12 cases of diarrhea （30.0%）, and 1 case of hypoleukemia （2.50%） in the control group. Conclusion CsA ＋ SRL ＋ Pred triple regimen can lead to more efficienct immunosuppressive effect and hyperlipidemia is the major side effect of SRL.

关 键 词：肾移植 西罗莫司 免疫抑制作用 

分 类 号：R699.2[医药卫生—泌尿科学]