他克莫司替换环孢素A延缓慢性移植肾肾病进展的临床研究  

Slowing progression of chronic allograft nephropathy by conversion from cyclosporin A to tacrolimus

作　　者：彭龙开[1] 谢续标[1] 彭风华[1] 王彧[1] 姜奕[1] 蓝恭斌[1] 方春华[1] 聂曼华[1] 

机构地区：[1]中南大学湘雅二医院器官移植中心,长沙410011

出　　处：《中南大学学报（医学版）》2007年第1期59-62,共4页Journal of Central South University ：Medical Science

摘　　要：目的:探讨他克莫司(FK506)替换环孢素A(CsA)治疗慢性移植肾肾病(CAN)的有效性及安全性。方法:根据是否以FK506替换CsA,将73例CAN患者分成两组,CsA组30例,维持原免疫抑制方案(CsA、霉酚酸酯及泼尼松联用)不变,采用替换方案的FK506组43例,除将CsA转换成FK506外,其他用药同CsA组。两组均随访1年以上,监测血清肌酐(SCr)、肾小球滤过率(GFR)、24h尿蛋白定量、血脂[包括总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)]等生化指标的变化情况,并观察随访期间药物的毒副作用。结果:转换治疗12个月后,FK506组SCr显著低于CsA组[分别为(194.8±42.5)μmol/Lvs.(245.4±52.8)μmol/L,P<0.01],FK506组GFR显著高于CsA组[(50.14±3.92)mL/(min.1.73m2)vs.(40.58±2.49)mL/(min.1.73m2),P<0.01];FK506组24h尿蛋白定量显著低于CsA组[(2.0±0.5)gvs.(3.9±0.7)g,P<0.01];FK506组除HDL外,TC,TG,LDL均显著低于CsA组[(5.19±0.73)mmol/Lvs.(6.94±1.37)mmol/L;(1.86±0.84)mmol/Lvs.(3.14±1.38)mmol/L;(3.03±0.71)mmol/Lvs.(3.82±0.89)mmol/L,P<0.01];FK506组震颤发生率较CsA组高(P<0.01),但高血压发生率显著低于CsA组(P<0.05)。结论:FK506转换治疗后,肾功能减退得到延缓,蛋白尿降低,血脂代谢得到改善,FK506可以有效延缓CAN进展。Objective To investigate the feasibility and safety of substituting tacrolimus （ FK506 ） for cyclosporin A （ CsA ） on delaying the pace of renal dysfunction in patients with biopsyproven chronic allograft nephropathy （CAN）. Methods Seventy-three renal transplantation patients with CAN proved by allograft biopsy were collected in this study. Patients were randomly divided into 2 groups. Patients were either converted to FK506 （ FK506 group, n = 43 ） or remained on their initial CsA-based immunosuppression （CsA group, n = 30 ）. The clinical data at study entry and after 12 months including blood urea nitrogen （ BUN ） , serum creatinine （ SCr ） , glomerular filtration rate （ GFR ） , 24-hour urine protein excretion, serum total cholesterol （ TC ） , triglyceride （ TG ） , low density lipoprotein （LDL）and the side effects of calcineurin inhibitors were monitored during a follow-up of over 12 months. Results Twelve months later, the level of SCr was statistically reduced and GFR levels were obviously elevated in the FK506 group as compared with CsA group [ （194.8 ±42.5 ） μmol/L vs. （ 245. 4 ± 52. 8 ） μmol/L and （ 50. 14 ± 3. 92 ） mL/（ min · 1. 73 m^2 ） vs. （40.58 ± 2.49 ） mL/（ min · 1.73 m^2 ） , P 〈 0.01 ]. Quantity of 24-hour urine protein excretion in the FK506 group was （2.020.5） g which is significantly lower than （3.9 ±0.7） g in the CsA group （ P 〈 0.01 ）. TC, TG, and LDL levels remained unchanged in the CsA group, while those were statistically reduced in the FK506 group respectively [ （ 5. 19 ± 0. 73 ） mmol/L vs. （6.94±1.37） mmol/L,（1.86 ±0.84） mmol/L vs. （3. 14 ±1.38） mmol/L,（3.03 ±0.71） mmol/L vs. （3.82 ±0.89） mmol/L,P 〈 0.01]. Tremor obviously increased （P 〈0.01 ） and hypertension obviously decreased （ P 〈 0.05 ） in the FK506 group compared with the CsA group. Conclusion FK506 treatment can greatly improve the proteinuria and hyperlipidemia. Conversion from CsA to FK506 is an

关 键 词：他克莫司 环孢菌素 肾移植 肾病 移植物 

分 类 号：R699.2[医药卫生—泌尿科学]