普乐可复替换环孢菌素A治疗和预防骨髓移植术后急性移植物抗宿主病40例临床观察  

Clinical study of treatment and prophylaxis for graft-versus-host disease from cyclosporine to tacrolimus after bone marrow transplantation

作　　者：王婧[1] 黄晓军[1] 许兰平[1] 刘代红[1] 陈欢[1] 陈育红[1] 韩伟[1] 王昱[1] 刘开彦[1] 

机构地区：[1]北京大学人民医院血液病研究所,北京100044

出　　处：《中国实用内科杂志》2009年第9期839-841,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的观察用普乐可复(FK506)替换环孢素A(CsA)预防和治疗骨髓移植术后急性移植物抗宿主病(GVHD)的有效性和安全性。方法回顾性分析2003年11月至2006年11月北京大学人民医院血液研究所收治的40例骨髓移植术后患者的临床资料。所有患者术后均采用以CsA+霉芬酸酯+短程甲氨蝶呤(MTX)为主的免疫抑制方案,因不能耐受CsA的副反应或在应用CsA的过程中出现不易控制的GVHD,用FK506替换CsA。观察患者皮疹、腹泻、肝功能等临床情况,同时监测尿素氮、肌酐、血糖、血脂、血压和FK506的血药浓度。结果因不能耐受CsA的副反应而改用者,原有的副反应均有所改善;为加强免疫抑制的治疗作用而改用者,81.8%(18/22)患者有效控制了急性GVHD;用FK506替换治疗后,17.5%(7/40)患者在同时应用FK506及可耐过程中出现可逆性血尿素氮、肌酐升高,17.5%(7/40)例患者出现可逆性血糖升高,2.5%(1/40)例患者出现药物可控性高血压;平均随访13个月,5%(2/40)患者复发,72.5%(29/40)患者存活。结论FK506用于急性GVHD的治疗和预防安全有效,在不能耐受CsA或需加强免疫抑制的患者中可以应用。Objective To study the feasibility and safety of tacrolimus （ FKS06 ） substituting for cyclosporine A （ CsA ） in the treatment and prophylaxis of acute graft-versus-host disease after bone marrow transplantation. Methods The clinical data in forty cases after bone marrow transplantation were retrospectively reviewed. All the patients received cyclosporine, mycophenodate mofetil and methotrexate based immunosuppressive treatment. FK506 were substituted for CsA in patients who couldn＇t tolerant the side effect of CsA and in patients with GVHD that fs not easy to control. Rash, diarrhea, hepatic function and clinical symptoms were observed. Blood urea nitrogen （BUN）, serum creatinine （Cr）, blood glucose （BG） , and whole blood FK506 through concentration were monitored. Results All the patients who couldn＇t tolerant with side effect of CsA benefited from replacing with FK506. 18 of 22 patients had rescued GVHD successfully after shift to FK506 therapy for intensive immunosuppression. After use alternative medicine with FK506,7 of 40 patients take place rise of BUN and Cr reversibility in the application of FK506 and foscarnet sodium simultaneously. 7 of 40 patients take place rise of BG reversibility. 1 of 40 patients takes place high blood pressure but drug controllability. Follow-up 13 month average, 2 of 40 patients relapse, and 29 of 40 patients survival. Conclusion FK506 was an effective and safe alternative in treatment and prophylaxis for acute GVHD,and could be used in patients who couldn＇t tolerant the side effect of CsA and in patients needing intensive immunosuppression.

关 键 词：免疫抑制剂 骨髓移植 普乐可复 环孢素A 

分 类 号：R5[医药卫生—内科学]