肾移植术后抗排斥药FK506的临床应用  

CLINICAL USE OF FK506 AS PRIMARY ANTI REJECTION AGENT IN RENAL ALLOGRAFT RECIPIENTS

作　　者：林宗明[1] 张永康[1] 王国民[1] 朱同玉[1] 戎瑞明[1] 方银忠 蒋金根[1] 

机构地区：[1]上海医科大学中山医院泌尿科,上海200032

出　　处：《肾脏病与透析肾移植杂志》2000年第3期240-242,共3页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的 :研究FK5 0 6预防肾移植术后排斥反应的效果和安全性。　 方法 :肾移植患者 2 2例 ,其中 1 8例为始用组 ,4例为切换组。FK5 0 6起始用 0 2mg/ (kg·d) ,以后逐步减量 ,3个月后维持血浓度于 3～ 1 2 μg/L水平。切换组于停用CsA 2 4h后应用FK5 0 6 ,剂量和血浓度与始用组相同。同时合并应用MMF 0 5g ,每日 3次口服 ,以及术后前 1 0天大剂量甲基强的松龙静滴 ,第 1 1天改强的松口服并减量 ,6个月后维持强的松 1 5mg/d。所有病例均严密观察并行血尿等生化分析。　 结果 :始用组移植肾功能好 ,平均血肌酐水平 1 0 2 μmol/L ,无一例出现排斥反应。切换组中 2例异常的肝功能好转 ;肾功能进行性减退的 2例切换后 ,血肌酐相对稳定。有血糖升高 4例和高血压 5例 ,用药后能控制 ,其他副反应有上呼吸道和下尿路感染、胸痛、恶心、呕吐、腹泻、腹部不适等。　 结论 :FK5 0 6是肾移植术后有确切疗效的基础抗排斥药 ,与MMF、皮质醇合用能有效地预防急性排斥的发生 ,并可控制慢性排斥的进展。应用剂量适当 ,无明显的肝、肾毒副作用 ,但有血糖升高及高血压副作用 ,药物可以控制。其它呼吸道、尿路、消化道和神经系统副反应轻 。OBJECTIVE To report our primary experience with the efficacy and safety of FK506 in the prevention of renal allograft rejection. METHODOLOGY Between Oct 1998 and Feb 2000,22 cases of renal recipients (male/female 17/5)administered FK506 as the primary anti rejection agent in their anti rejection regime(FK506,MMF,steroid).For the 18 patients who started FK506 treatment after transplantation,the initial dosage of FK506 was 0 2 mg/(kg·d) with the trough serum concentration about 6 15 μg/L,and the dosage was tailed off within the first 6 months,and trough serum level of FK506 maintained at 3 12 μg/L thereafter.For the 4 patients switched from cyclosporin A treatment to FK506 treatment,FK506 was started at 0 2mg/(kg·d) and adjusted to maintained the trough serum level in the rang of 3 12 μg/L. RESULTS In patients started FK506 treatment after operation,there was no loss of graft or patients,nor rejection episodes observed.In 2 patients switched from CsA for hepatoxicity,hepatic function recovered to normal,and in another 2 patients switched from CsA for chronic renal graft rejection,serum creatinine remained stable.Hyperglycemia was observed in 4(18 2%),hypertension in 5(22 7%),respiratory infection in 2(9 1%),urinary tract infection in 3(13 6%). CONCLUSION FK506 used as a primary anti rejection agent is effective and safe in renal graft recipients.Combination of FK506 and MMF plus steroids is the best regime for the prevention of both acute and chronic rejection.

关 键 词：肾移植 排斥反应 FK506 临床应用 

分 类 号：R699[医药卫生—泌尿科学]