环孢素A短期替代他克莫司对肾移植后新发糖尿病的改善作用  

A short term of CsA interval in TAC related new-onset diabetes mellitus after renal transplantation

作　　者：苗芸[1] 于立新[1] 邓文锋[1] 付绍杰[1] 徐健[1] 杜传福[1] 王亦斌[1] 叶桂荣[1] 张新科[1] 周敏捷[1] 

机构地区：[1]南方医科大学南方医院器官移植科,广州510515

出　　处：《中华器官移植杂志》2012年第1期14-17,共4页Chinese Journal of Organ Transplantation

摘　　要：目的初步探讨环孢素A（CsA）短期替代他克莫司（Tac）对移植后新发糖尿病（NODAT）的改善作用。方法前瞻性分析19例以Tac为基础免疫抑制剂的NODAT患者的资料。其中7例NODAT诊断明确后将Tac转换为CsA，6个月后再次转换回Tac（转换组）；12例诊断为NODAT后继续应用Tac（对照组）。结果转换组空腹血糖（FPG）由入组时的（8．3±3．9）mmol／L降至转换12个月时的（5．6±1．8）mmol／L（P〈0．01），对照组入组时和12个月时的FPG分别为（8．1±3．5）mmol／L和（8．0±3．0）mmol／L（P〉0．05），组间12个月时相比较，差异有统计学意义（P〈0．05）。转换组糖化血红蛋白（HbAlc）由入组时的（6．8±0．8）％降至12个月时的（6．1±0．4）％（P〈0．05），对照组入组时和12个月时的HbAlc分别为（6．9±0．7）％和（6．8±1．5）％（P〉0．05），两组间12个月时相比较，差异有统计学意义（P〈0．05）。随访结束时，转换组中4例（57．1％，4／7）NODAT完全缓解，而对照组中无NODAT缓解病例（P〈0．01）。转换组血压和血脂水平在转换之后维持稳定。两组间移植物功能以及急性排斥反应发生率的差异无统计学意义（P〉0．05）。两组随访结束时移植物和受者存活率均为100％。结论发生NODAT的肾移植受者将Tac短期（6个月）转换为CsA，可明显改善糖代谢异常。Objective To investigate the effectiveness and safety of a short term of CsA interval in TAC related new-onset diabetes mellitus （NODAT） after renal transplantation. Methods Clinical data of 19 NODAT patients in TAC-based regiment were analyzed. Two groups of patients with NODAT were identified. In 7 patients, TAC was converted to CsA, and 6 months later to TAC again （converted group）; in 12 patients, TAC was given continuously （control group）. Results In the converted group, FPG was decreased from 8.3 ± 3. 9 mmol/L at the time of conversion to 5.6± 1.8 mmoI/L 12 months later （P〈0. 01）, and in the control group, that was 8.1 ±3.5 mmol/L and 8.0± 3.0 mmol/L respectively （P〉0. 05）. There was a great significant difference between groups （P〈 0. 05）. In the converted group, HbAlc levels were decreased from 6. 8%± 0. 8% to 6. 1 % ± 0. 4% at 12th month （P〈0. 05）, while in the control group, HbAlc levels were 6. 9%±I}. 7% to 6. 8% ± 1.5% （P〉0. 05）. There was also a great significant difference between groups （P〈0. 05）. After follow-up for 12 months, 4 （57. 1%） of converted patients no longer had diabetes versus 0% in the control group （P〈0. 01）. Blood pressure and lipid levels were stable after conversion. The conversion was safe in terms of graft function and acute rejection episodes. The 1-year patient survival and graft survival rate was 100%. Conclusion This primary study suggests a significant improvement of glucose metabolism after a short term conversion to CsA in renal transplant patients with NODAT.

关 键 词：肾移植 糖尿病 他克莫司 环孢菌素 

分 类 号：R692[医药卫生—泌尿科学]