肾移植受者因环孢素所致药源性疾病而转换为他克莫司的回顾性研究  

Retrospective study on curative effect of tacrolimus used in renal transplant recipients

作　　者：王学彬[1] 章玥[1] 王卓[1] 曹爱霖[1] 田泾[1] 高丽红[1] 肖成武[2] 张文静[1] 钱皎[1] 严萍萍[1] 丁楠[1] 尹东峰[3,4] 

机构地区：[1]上海长海医院药学部,上海200433 [2]上海长海医院泌尿外科,上海200433 [3]上海长海医院 [4]兰州军区乌鲁木齐总医院药剂科,乌鲁木齐830000

出　　处：《世界临床药物》2014年第1期20-24,41,共6页World Clinical Drug

基　　金：上海市医院药学科研基金课题(No.2011YY0101);上海市医院药学科研基金课题(No.2011YY0433);第二军医大学长海医院"1255"基金--学科特色提升项目(No.CH125520400)

摘　　要：目的探讨肾移植受者在以环孢素为基础的免疫抑制剂方案治疗期间发生药源性疾病(DID)后,将环孢素切换为他克莫司后对疗效的影响。方法通过收集92例将环孢素切换为他克莫司的肾移植受者的临床资料,分析切换后1年内环孢素所致DID改善的情况。结果与未切换方案时相比,发生急性排异反应(AR)和爬行肌酐(CScr)的肾移植受者在切换方案后1、3、6和12个月的血肌酐(Scr)和尿素氮(BUN)均下降(P<0.05或0.01);发生药物性肝损伤(DILI)者在切换方案后1、3、6和12个月的直接胆红素(DB)、总胆红素(TB)均下降(P<0.05或0.01),在切换方案后12个月时谷丙转氨酶(ALT)降低(P<0.05);牙龈增生(GH)在切换方案1个月后逐渐消失。但切换方案后肾移植受者空腹血糖(FPG)却逐渐升高,并在12个月时显著升高(P<0.05)。结论血糖正常的肾移植受者,如发生与环孢素有关的AR、CScr、DILI和(或)GH等严重DID,将环孢素切换为他克莫司,可有效提高肾移植受者的生存质量和生存期。Objective To explore the curative effect for renal transplant recipients whose main immunosuppressant was switched from cyclosporine to tacrolimus because of DID （drug-induced disease） caused by cyclosporine. Methods The clinical follow-up data of renal transplant recipients who switched immunosuppressant from cyclosporine to tacrolimus were collected. And the clinical therapeutic outcomes were systematically analyzed. Results Compared to before switching, the levers of Scr and BUN were signifcantly decreased （P〈0.05 or 0.01） in 1, 3, 6 and 12 months after switching. The levers of direct bilirubin （DB） and total bilirubin （TB） were also signifcantly decreased （P〈 0.05 or 0.01） in 1, 3, 6 and 12 months for drug-induced liver injury （DILl） recipients. And the ALT average lever was signifcantly decreased in 12 months after conversion （P〈O.05）. The serious complications of gingival hyperplasia （GH） were usually stopped by tacrolimus in 1 month after the switching. However, the levers of fasting plasma glucose （FPG） were significantly increased （P〈0.05）. Conclusion For the renal transplant recipients with normal blood sugar, if they have suffered from the serious DID of AR, CScr, DILI and（or） GH during the therapeutic period with cyclosporine-based immunosuppressive regimens, conversion from cyclosporine to tacrolimus should be considered and might be benifcial to improve life qualiW and graft survival.

关 键 词：环孢素 他克莫司 肾移植术 药物不良反应 药源性疾病 

分 类 号：R979.5[医药卫生—药品] R692.5[医药卫生—药学]