肝移植后并发他克莫司不良反应者的西罗莫司单药转换治疗14例  

Sirolimus monotherapy in liver transplant recipient： a report of 14 cases

作　　者：鞠卫强[1] 何晓顺[1] 王东平[1] 巫林伟[1] 邰强[1] 胡安斌[1] 马毅[1] 朱晓峰[1] 黄洁夫[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中华器官移植杂志》2009年第5期287-289,共3页Chinese Journal of Organ Transplantation

基　　金：基金项目：广东省自然科学基金（06104600）

摘　　要：目的总结出现钙调磷酸酶抑制剂（CNI）相关并发症的患者采用西罗莫司（SRL）单药转换治疗的体会。方法肝移植患者14例，其中因CNI类药物致肾功能受损而行转换治疗者13例，因移植后血糖升高而行转换治疗者1例。转换治疗前，患者采用他克莫司（Tac）和糖皮质激素预防排斥反应，部分患者还加用霉酚酸酯。进行转换治疗后，初次给予SRL4mg／d；1周内给予SRL1～2mg／d，同时Tac的用量减至原来的一半；治疗1周后，根据血SRL浓度调整其剂量，维持血SRL浓度谷值为5～10μg／L，于转换治疗后1～2周完全撤除Tac。观察患者转换治疗后并发症的改善情况，肾功能、肝功能和急性排斥反应的发生情况及药物不良反应等。结果转换治疗前，13例肾功能受损者的血肌酐为（158．3±41．6）μmol／L，随访结束时降低到（103．7±21．2）μmol／L；另1例血糖升高者在转换治疗后血糖得到有效控制，胰岛素用量由转换前的80IU／L减少至24IU／L。转换治疗后6个月内，14例中有2例（14．3％）发生急性排斥反应，治疗后均逆转。随访过程中，4例出现血脂升高，4例出现贫血或血小板减少，5例出现溃疡型口疮，但无患者因SRL不良反应而终止转换治疗。结论肝移植术后出现CNI相关并发症的患者可以采用SRL单药转换治疗。Objective To evaluate the efficacy and safety of conversion from calcineurin inhibitors （CNI） to sirolimus among liver transplant recipients with CNI-induced complications. Methods Fourteen patients with CNI-induced complications （13 cases of renal dysfunction and 1 case of diabetes mellitus） after liver transplantation received the immunosupressive stragtegies of tacrolimus withdrawn and sirolimus conversion. Serum creatinine, sirolimus level, liver function, rejection episodes and drug side-effect were monitored. Results All patients were followed up from 12 to 36 months. Three months after conversion, serum creatinine levels were decreased significantly in 13 patients with renal dysrfunction （118. 2 ± 22. 5 vs 158. 3 ± 41.6μmol/L, P〈0. 05）. One patient with diabetes mellitus was cured after conversion to sirolimus. Two patients had experienced one episode of rejection, and one patient with rejection needed intravenous steroid bolus. The side-effects of sirolimus included hyperlipidemia （4 cases）, anaemia （4 cases） and mouth ulcers （ 5 cases）. Conclusion Sirolimus monotherapy is effective and safe in liver transplant recipients. Conversion to sirolimus was associated with a sustained improvement in renal function and diabetes mellitus.

关 键 词：肝移植 西罗莫司 钙神经素抑制剂 肾功能衰竭 糖尿病 

分 类 号：R686[医药卫生—骨科学]