他克莫司转换为环孢素A改善肾移植后新发糖尿病  

Conversion from tacrolimus to cyclosporine A improves new-onset diabetes mellitus after transplantation

作　　者：冯小芳[1] 闵敏[1] 左富姐[1] 周梅生[2] 王立明[2] 

机构地区：[1]上海市闸北区中心医院(长征医院闸北分院)肾移植康复科,上海市200070 [2]解放军第二军医大学上海长征医院器官移植中心,上海市200070

出　　处：《中国组织工程研究》2013年第53期9176-9181,共6页Chinese Journal of Tissue Engineering Research

基　　金：上海市闸北区卫生局(2013QN02)~~

摘　　要：背景:肾移植后糖尿病的发生原因目前尚不明确,一般认为与患者种族、年龄、体质量、家族史、丙肝病毒感染及免疫抑制剂方案有关目的:探讨将他克莫司转换为环孢素A改善移植后新发糖尿病的有效性和安全性。方法:将42例符合入组标准的肾移植受者随机分为转换组(n=20)和对照组(n=22);转换组将他克莫司转换为环孢素A,对照组不转换。从对照组确诊为新发糖尿病、转换组他克莫司转换为环孢素A的时间开始随访1年,动态监测患者的血糖状况,同时监测患者体质量指数、血清肌酐、尿素氮、尿酸、肝功能、血脂、免疫抑制剂用量及浓度范围、尿微量白蛋白、急性排斥反应发生率、感染发生率、丙肝感染率、人/肾存活率等直至随访终点。结果与结论:随着时间的增长,转换组的空腹血糖及糖化血红蛋白逐渐改善,需要接受降糖治疗的患者例数逐渐减少,转换1年后,有11例(55%)新发糖尿病完全缓解,不需接受降糖药物治疗;而对照组,需要接受降糖药物治疗的患者例数逐渐增多,1年后所有患者均需接受治疗,而且空腹血糖及糖化血红蛋白控制情况均不如转换组。同时,转换组与对照组相比,血清肌酐、谷丙转氨酶、三酰甘油、胆固醇、尿酸等均无明显差异,而尿微量白蛋白在转换后6个月开始则明显少于对照组;两组的急性排斥反应发生率、感染发生率及人/肾存活率均无明显差异。将他克莫司转换为环孢素A,短期内(1年内)改善肾移植后新发糖尿病是安全而有效的。BACKGROUND： The pathogenesis of new-onset diabetes mellitus after transplantation remains unclear. It is generally recognized that the onset is associated with patient’s ethnics, age, body weight, familial history, hepatitis C virus and immunosuppressant cheme.OBJECTIVE： To discuss the efficiency and safety of conversion from tacrolimus to cyclosporine A in renal transplant recipients with new-onset diabetes mellitus after transplantation.METHODS： Forty-two renal transplant recipients, who met the inclusion criteria, were divided into two groups randomly： conversion group （n=20; tacrolimus was converted to cyclosporine A） and control group （n=22; tacrolimus was given contrinuously）. All the involved patients were followed up for 1 year after the diagnosis of new-onset diabetes mellitus after ransplantation in control group and conversion from tacrolimus to cyclosporine A conversion group. The blood glucose levels of patients were dynamically monitored. Meanwhile body mass index, serum creatinine, urea nitrogen, serum uric acid, liver function, blood lipid, the dose and concentration range of immunosuppressants, urinary albumin, the incidence of acute rejection, infection rate of hepatitis C virus, the survival rate of patients and renal graft were all recorded.RESULTS AND CONCLUSION： With the time going, fasting blood glucose and glycosylated hemoglobin were improved gradually in conversion group and the number of cases needing glucose-lowering treatment was gradually decreased. Eleven cases （55%） presented a complete remission after one year and needed no glucose-lowering treatment. In the control group, the cases needing glucose-lowering treatment were increased gradually, and all cases still needed glucose-lowering treatment after one year. Fasting blood glucose and glycosylated hemoglobin levels were higher than those in conversion group. Meanwhile, serum creatinine, alanine aminotransferase, triacylglycerol, cholesterol and serum uric acid showed no differences between two groups, bu

关 键 词：器官移植 肾移植 糖尿病 他克莫司 环孢素A 空腹血糖 糖化血红蛋白 排斥反应 

分 类 号：R318[医药卫生—生物医学工程]