低剂量他克莫司为基础四联免疫抑制方案在肾移植中的应用:4年随访结果  

Application of quadruple immunosuppressive therapies based on low-dosage Tacrolimus in kidney transplantation: 4-year follow-up results

作　　者：黄赤兵[1] 许晓婷[1] 范明齐[1] 张艮甫[1] 王平贤[1] 冯嘉瑜[1] 肖亚[1] 

机构地区：[1]解放军第三军医大学新桥医院肾移植中心,重庆市400037

出　　处：《中国组织工程研究与临床康复》2011年第44期8217-8220,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景：免疫抑制药物日新月异的发展及药物应用存在较大的个体差异使得目前国内外对于肾移植后免疫抑制的选择和应用剂量等仍无法达成完全统一的共识。目的：观察以低剂量他克莫司为基础的四联免疫抑制剂方案的免疫抑制效能、保护肾功能的作用和安全性。方法：以他克莫司＋酶酚酸酯＋泼尼松龙（方案1）为对照组;将方案1中他克莫司和酶酚酸酯减量为方案2,以方案2＋西罗莫司为组1;方案2＋咪唑立宾为组2。检测3组受者肾移植后第2,4周、6个月及1年时淋巴细胞对供体树突状细胞的反应强度;每6个月测定1次受者尿转化生长因子β1;移植后每1~3个月检查肝肾功能、血尿常规、血糖,随访时间为4年。结果与结论：3组急性排斥反应发生率及感染发生率无显著差异;移植4周,组1,组2的反应强度明显低于对照组（P〈0.05）;移植1年,组1、组2尿转化生长因子β1浓度均显著低于对照组（P〈0.05）;移植2年,组1、组2血肌酐和肌酐清除率降低值均显著低于对照组（P〈0.05）;组1、组2肝功损害、高血糖等不良反应发生率均低于对照组（P〈0.05）。提示与常规剂量他克莫司为基础的三联免疫抑制方案相比,低剂量他克莫司为基础的四联免疫抑制方案能够发挥同样的免疫抑制效果,同时能减轻移植肾纤维化进程,改善移植肾功能,减少严重不良反应发生率,更有利于移植肾长期存活。BACKGROUND： There has been no consensus about selection and application dosage of immunosuppressive drugs after kidney transplantation due to great individual difference of drugs caused by gradual development and application. OBJECTIVE： To explore the immunosuppressive efficacy, the protective effects on renal function and the application safety of the quadruple immunosuppressive therapy based on low dosage of Tacrolimus （Tac） in kidney transplantation. METHODS： In the control group （schedule 1）, Tac, mycophenolate mofetil （MMF）, and prednisone were used. In the experimental group 1, reduced dose of Tac and MMF （schedule 2） and sirolimus （SRL） were used. In the experimental group 2, reduced dose of Tac and MMF （schedule 2） and mizoribine （MZR） were used. The recipient lymphocyte reaction in each group was detected at 2, 4 weeks, 6 months and 1 year after surgery. Urine transforming growth factor -β1 was tested once every 6 months. Liver and renal function, blood and urine routine, and blood glucose were examined every 1-3 months after kidney transplantation. All patients were followed up for 4 years. RESULTS AND CONCLUSION： There was no significant difference in acute rejection and infection rate among the three groups. At 4 weeks after transplantation, the recipient lymphocyte reaction was significantly weaker in the experimental groups 1, 2 than in the control group （P 0.05）. At 1 year after transplantation, transforming growth factor β1 concentration was significantly lower in the experimental groups 1, 2 than in the control group （P 0.05）. At 2 years after transplantation, serum creatinine and creatinine clearance rate were significantly lower, and adverse events including liver damage and high glucose, were fewer in the experimental groups 1, 2 than in the control group （P 0.05）. These findings suggest that compared with the triple immunosuppressive therapy based on conventional dose of Tac, the quadruple immunosuppressive therapy shares the same immunosuppre

关 键 词：四联免疫抑制治疗 肾移植 免疫抑制效能 转化生长因子 不良反应 

分 类 号：R617[医药卫生—外科学]