来氟米特用于肾移植患者长期维持治疗20例  

Long-term maintenance therapy of leflunomide in 20 renal allograft recipients

作　　者：韩国锋[1] 胡大勇[1] 张金元[1] 周传业[1] 孙晶[1] 周巍[1] 

机构地区：[1]解放军第四五五医院,上海市200052

出　　处：《中国组织工程研究与临床康复》2009年第18期3519-3522,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:来氟米特作为一种新型免疫抑制剂广泛应用于治疗自身免疫性疾病,它兼有免疫抑制作用和抗病毒活性,初步临床观察提示它可用于器官移植抗排斥治疗,但长期疗效尚不清楚。目的:评价来氟米特+环孢霉素(或他克莫司)+泼尼松三联药物对肾移植受者维持治疗的长期效果。设计、时间及地点:回顾性病例分析,2002-12/2007-03在解放军第四五五医院,解放军南京军区肾脏专科中心完成。对象:选取肾移植术后超过1个月且肾功能正常者。来氟米特治疗组:用氟米特替换霉酚酸酯或硫唑嘌呤患者20例,移植时年龄16～47岁,平均(32.6±8.7)岁,其他免疫抑制剂与对照组相同。对照组:同期肾移植患者41例,年龄17～57岁,使用霉酚酸酯+环孢素A/他克莫司+泼尼松为维持治疗。方法:来氟米特起始剂量为50mg/d,应用3～5d后给予20mg/d维持;泼尼松维持剂量为10mg/d;环孢素A或他克莫司剂量根据其血药浓度进行调整。前3个月每月复查肝功能、肾功能和血常规,以后根据患者情况1～3个月复查1次。主要观察指标:来氟米特治疗组和对照组移植肾和患者生存率,及来氟米特不良反应。结果:来氟米特组观察时间平均(27.7±21.6)个月。继续维持来氟米特治疗肾功能稳定7例,血肌酐翻倍或肾功能丢失2例,失访1例,退出10例。来氟米特组人、肾生存率分别为1年100%和100%,3年100%和94%,5年79%和78%。对照组人、肾生存率分别为1年95%和95%,3年90%和88%,5年90%和77%。死亡原因:来氟米特组2例移植肾失功后放弃透析治疗;霉酚酸酯组2例带功死于肺部感染,2例于移植肾失功后因经济困难放弃治疗。来氟米特不良反应:早期脱发3例,皮疹2例,恶心3例,贫血2例。结论:用来氟米特+钙调素抑制剂+泼尼松三联治疗和霉酚酸酯+钙调素抑制剂+泼尼松三联治疗的肾移植受者5年的临床结果无明显差别。BACKGROUND： Leflunomide, a new immunosuppressive agent, has been widely used for treating autoimmune disease. Leflunomide has immunosuppressive action and antiviral activity. Primary observation showed that leflunomide can be used in organ transplantation to resist rejection therapy, but the long-term curative effect is unclear. OBJECTIVE： To evaluate the long-term effect of leflunomide ＋ cyclosporine ＋ prednisone in renal allograft recipients. DESIGN, TIME AND SETTING： The retrospective case analysis was performed at the 455 Hospital of Chinese PLA, and Kidney Center of Nanjing Military Area Command of Chinese PLA from December 2002 to March 2007. PARTICIPANTS： Patients with stable renal function more than 1 month after transplantation were involved in the study. In the leflunomide group, 20 patients received leflunomide, instead of mycophenolate or azathioprine. The transplantation age ranged from 16 to 47 years, averagely （32.6±8.7） years. Other immunosuppressive agents were the same as the control group. In the control group, 41 patients undergoing renal transplantation, aged 17 57 years, received mycophenolate ＋ cyclosporine A/tacrolimus ＋ prednisone. METHODS： Leflunomide dose was 50 mg/d, and changed into 20 mg/d following 3-5 days. Prednisone dose was 10 mg/d. Cyclosporin A or tacrolimus dose was regulated by blood drug level. During the first 3 months, hepatic function, renal function and blood conventional examination were reviewed every month. Subsequently, one review was done every 1 3 months. MAIN OUTCOME MEASURES： Survival rate of renal graft and patients in the leflunomide and control groups, as well as side effects of leflunomide were measured. RESULTS： Average leflunomide treatment time was （27.7±21.6） months. 7 patients were still on leflunomide with stable renal function, 2 lost kidney function, 10 withdrew, and 1 lost following up. In leflunomide group, patients/renal survival rates were： one year 100% and 100%, 3 years 100% and 94%, 5 years 79%/78%

关 键 词：肾移植 来氟米特 生存率 

分 类 号：R617[医药卫生—外科学]