将钙调磷酸酶抑制剂转换为西罗莫司在慢性移植肾肾病中的临床治疗效果  

Clinical effect of conversion to Rapamycin on chronic allograft nephropathy

作　　者：夏盛强[1] 范昱[2] 邱建新[2] 龚华[2] 彭波[1] 车建平[1] 郑军华[1] 

机构地区：[1]上海市第十人民医院泌尿外科,200072 [2]上海市第一人民医院肾移植科

出　　处：《中华器官移植杂志》2013年第3期163-166,共4页Chinese Journal of Organ Transplantation

摘　　要：目的探讨慢性移植肾肾病（CAN）患者将免疫抑制方案中钙调磷酸酶抑制剂（CNI）转换为西罗莫司（SRL）的有效性及安全性。方法选取72例经移植肾活检证实发生CAN的受者，其中35例将免疫抑制方案中CNI转换为sRL（SRL组），其余37例继续原CNI方案（CNI组）。另取10例因其他原因将CNI转换为SRL治疗的受者，将45例转换为SRL的患者分为A组[血肌酐（SCr）〈120umol／L），B组（SCr为120-200umol／L，且Banff分级为I～Ⅱ级），C组（SCr为120～200umol／L，且Banff分级在Ⅱ级以上），D组（SCr〉200umol／L）。随访期为24个月，检测各组随访期内的各临床指标。结果转换治疗前，两组间SCr和肾小球滤过率（eGFR）的差异无统计学意义（P〉0．05）；转换治疗后24个月内，SRL组SCr水平和eGFR较CNI组明显改善（P〈0．05），而CNI组的移植肾功能有逐渐衰退的趋势。SRL组尿蛋白及血脂明显上升（P〈0．05），而CNI组变化不大；SRL组血小板计数较CNI组明显下降（P〈0．05），两组间其他指标的差异无统计学意义（P〉0．05）。A组患者各指标在转换治疗前后的变化并不大，B组患者的肾功能及蛋白尿有改善明显，C组和D组患者肾功能有不同程度衰退情况，且蛋白尿加重。结论SRL转换治疗对于稳定及改善CAN患者的移植肾功能是有效、安全的，CAN早期进行转换（SCr〈200umol／L）效果明显。Objective To study the effect and safety of conversion from calcineurin inhibitors to rapamycin in kidney transplantation recipients with chronic allograft nephropathy. Methods In 82 kidney transplant recipients enrolled in this study, 72 cases were diagnosed as having chronic allograft nephropathy by biopsy. Recipients （SRL group） were administered with rapamycin after withdrawal of calcineurin inhibitors. The doses of CNI in other recipients （non-SRL group） were not changed. Renal function, proteinuria, blood pressure, blood fat, hepatic function and hemogram were observed for 24 months in each group. Results During the follow-up period, serum creatinine level was dropped significantly in SRL group （P〈0. 05）, but it was increased in non-SRL group （P〈0. 05）. SRL group showed increased proteinuria, serum cholesterol and triglycerides （P〈0. 05）, and reduced Plt （P〈 0. 05）. According to the renal function before conversion, the recipients who were administered rapamycin divided into four groups. In group A （Scr 〈 120 umol/L）, there was no significant difference in diverse variables before and after conversion. In group B （Scr 120-200 umol/L and Banff I - II ）, renal function was improved, and proteinuria alleviated. In group C （Scr 120-200 umol/L and Banff 〉 II ）, and group D （Scr 〉200 umol/L）, renal function was damaged to varying degrees and proteinuria was deteriorated. Conclusion It is safe and effective for patients with chronic allograft nephropathy to convert from calcineurin inhibitors to rapamycin.

关 键 词：肾移植 慢性移植肾肾病 西罗莫司 

分 类 号：R699.2[医药卫生—泌尿科学]