儿童肾移植术后的免疫抑制治疗  

Comparison of the immunosuppressive therapies for kidney transplantation in children

作　　者：杨顺良[1] 吴卫真[1] 林文洪[1] 徐廷昭[1] 蔡锦全[1] 陶小琴[1] 王庆华[1] 王栋[1] 高霞[1] 谭建明[1] 

机构地区：[1]南京军区福州总医院泌尿外科,全军器官移植中心,福州350025

出　　处：《中华小儿外科杂志》2008年第2期97-100,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨长期存活的儿童肾移植受者不同免疫抑制方案的有效性与安全性。方法回顾性分析34例存活5年以上的儿童受者免疫抑制剂使用情况，按所使用的免疫抑制剂不同分为5组：A组：环孢素A＋强的松；B组：环孢素A＋硫唑嘌呤＋强的松；C组：环孢素A＋霉酚酸酯＋强的松；D组：他克莫司＋硫唑嘌呤＋强的松；E组：他克莫司＋霉酚酸酯＋强的松。结果术后按Kaplan-Meier法得出1、3、5年人／肾存活率分别为100％／97％、91％／87．8％、84．4％／80．9％。术后1、3、5年时肾存活的33例、30例和28例中，服用环孢素A者为16／33（48．5％）、18／30（60％）、15／28（53．6％），服用他克莫司者为17／33（51．5％）、12／30（40％）、13／28（46．4％）；服用硫唑嘌呤者为7／33（21．2％）、7／30（23．3％）、9／28（32．1％），服用霉酚酸酯者为26／33（78．8％）、21／30（70％）、17／28（60．7％）。移植1年后环孢素A血浓度谷值100～150ng／ml，他克莫司血浓度1．5～3ng／ml。各组不同时期的环孢素A和他克莫司剂量和浓度均无明显差异。霉酚酸酯剂量维持在10mg·kg^-1·d^-1，强的松5～10mg／d。服药不依从者占30％。移植肾丢失5例，原因分别为排异反应1例，移植肾带功能死亡4例（肺部感染和药物性肝功能损害各2例）。并发症包括高血压（35．7％）、高血脂（28．6％）、感染（17．9％）、牙龈增生（14．3％）、多毛（10．7％）、糖尿病（3．6％）。结论环孢素A／他克莫司、霉酚酸酯、强的松三联免疫抑制治疗是儿童肾移植受者主要的抗排异方案，须定期监测血药浓度，个体化调整剂量。Objective To explore the efficacy and safety of the different immunosuppressive regimens on the longterm survival of renal allografts in pediatric recipients. Methods The clinical data of 34 transplanted patients were analyzed. The recipients were divided into five groups： group A received cyclosporine and steroid; group B received cyclosporine, azathioprine and steroid; group C received cyclosporine, mycophenolante mofetil （MMF） and steroid; group D received Tacrolimus, azathioprine and steroid; and group E received Tacrolimus, MMF and steroid. Results The recipient/ graft survival rates after 1, 3, and 5 years were 100%/97%, 91%/87. 8% and 84. 4%/80. 9% respectively. The survival rates of Cyclosporine-based and Tacrolimus-based immunosuppression at 1, 3 and 5 year were 48. 5%/51.5% ,60%/40% and 53.6/43. 4% respectively. The survival rates for azathioprine and MMF group were 21.2%/78. 8%, 23.3%/70%,32. 1%/60. 7% respectively. The dosage of Cyclosporine was 2-3 mg ·kg^-1· d^-1, with the trough levels between 100 ng/mL to 150 ng/mL. When Tacrolimus was used, the dosage was 0. 03-0. 05 mg·kg^-1·d^-1 , with its trough level ranging from 1.5 ng/mL to 3 ng/mL. There were no significant difference of the dosage and blood for Cyclosporine or Tacrolimus at different period. The dosage of MMF was 10 mg·kg^-1 ·d^-1 , and prednisone was 5- 10 mg/d. The incompliance rate was 30%, and 5 patients lost their renal grafts, of which one suffered from rejection and four died with normal renal function, 2 from pulmonary infection, and 2 from drug induced liver impairment. The other complications included： hypertension 35. 7%, hyperlipidemia 28. 6%, infection 17. 9%, gingival hyperplasia 14. 3 %, hypertrichiasis 10. 7 %, and diabetes mellitus 3.6%. Conclusions Cyclosporine/Tacrolimus, MMF, plus prednisone regimen is the most effective immunosuppressive therapy for pediatric renal recipients.

关 键 词：肾移植 免疫抑制剂 存活率 

分 类 号：R699.2[医药卫生—泌尿科学]