3种免疫抑制剂替换方案治疗肾移植术后“爬行肌酐”的疗效观察  

Three Immunosuppressant Conversion Protocols in Kidney Transplant Recipients with Creeping Creatinine

作　　者：倪晓洁[1] 郑少玲[1] 杨亦荣[1] 夏鹏[1] 陈必成[1] 吴存造[1] 孙贤斌[1] 蔡勇[1] 

机构地区：[1]温州医学院附属第一医院移植中心,温州325000

出　　处：《中国中西医结合肾病杂志》2008年第11期974-977,共4页Chinese Journal of Integrated Traditional and Western Nephrology

摘　　要：目的:观察3种免疫抑制剂替换方案治疗肾移植术后"爬行肌酐"患者的疗效。方法:回顾性分析1992年12月～2005年11月间53例术后出现"爬行肌酐"肾移植受者的临床资料,按出现"爬行肌酐"后采用的替换治疗方案分为FK506组(n=24)、MMF组(n=18)和SRL组(n=11),观察治疗前后的移植肾功能及血压、血糖、血脂等的变化,并比较随访12个月的情况。结果:FK506组治疗后移植肾功能较前明显好转,血肌酐下降明显(P<0.05),同时降低了血脂水平,减少降脂药物及抗高血压药物的使用,替换后的血糖升高不明显;MMF组治疗后可以延缓大部分病例的移植肾功能减退,降低血脂水平,减少抗高血压药物的使用以及肝脏、骨髓毒性;SRL组治疗后亦可以延缓部分病例的移植肾功能恶化,但可引起或加重高脂血症及贫血。结论:对肾移植术后"爬行肌酐"患者采用的3种免疫抑制剂替换方案都可以有效地改善或稳定移植肾功能。Objective： To investigate the effect of three immunosuppressant conversion protocols on reversing creeping creatinine in kidney transplant recipients. Methods：A retrospective study was performed in 53 kidney recipients with creeping creatinine from December, 1992 to November, 2005 in our transplantation center. According to the conversion protocols, the patients were divided into FK506 group （ n = 24） ,MMF group （ n = 18） and SRL group （ n = 11 ）. Graft function, blood pressure, blood glucose and lipid profiles were monitored during the 12 - month follow- up intervals. Results： In FK506 group, there was a significant improvement in GFR and lipid profiles while less lipid - lowering and antihypertensive drugs were required after conversion. In MMF group, the graft function of most recipients was stable while decreasing the level of lipid profiles, reducing the dose of antihypertensive drugs, and lessening hepatotoxicity and myelosuppression were observed after conversion. In SRL group, the aggravation of some recipients＇ graft function was delayed but the incidence of hyperlipidemia and anemia was higher after conversion. Conclusion： These t conversion protocols can improve or stabilize the graft function in kidney transplant recipients with creeping creatinine.

关 键 词：肾移植 爬行肌酐 钙调神经抑制剂 西罗莫司 霉酚酸酯 

分 类 号：R699.2[医药卫生—泌尿科学] R979.5[医药卫生—外科学]