雷公藤多甙治疗肾移植后西罗莫司相关蛋白尿的临床研究  

Therapeutic effect of tripterygium wilfordii multiglycosides on proteinuria caused by sirolimus in renal transplant recipients

作　　者：季曙明[1] 倪雪峰[1] 李雪[1] 文吉秋[1] 程东瑞[1] 陈劲松[1] 

机构地区：[1]南京军区南京总医院国家肾脏疾病临床医学研究中心解放军肾脏病研究所,南京210002

出　　处：《医学研究生学报》2015年第4期380-384,共5页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81270834)

摘　　要：目的：已发现西罗莫司可导致肾移植患者蛋白尿。文中对应用西罗莫司联合霉酚酸酯和激素“三联”免疫抑制方案的肾移植受者进行临床观察，探讨雷公藤多甙（T Ⅱ）治疗西罗莫司相关蛋白尿的安全性和有效性。方法选择全军肾脏病研究所2009年4月至2012年12月间176例接受西罗莫司治疗的尸肾移植受者中，西罗莫司治疗6个月内出现尿蛋白的肾移植受者52例，包括9例新接受西罗莫司治疗和43例由钙调磷酸酶抑制剂（ calcineurin inhibitors， CNIs）更换为西罗莫司治疗患者。所有患者平均尿蛋白水平（4．5±2．8）g／24 h。将52例受者根据不同治疗方案纳入雷公藤治疗组（雷公藤组，n＝27）和缬沙坦组（n＝25），持续观察12个月。雷公藤组应用常规剂量雷公藤多甙[1 mg／（kg＆#183; d），雷公藤多甙含雷公藤内酯醇30μg／（10 mg＆#183;片）]；缬沙坦组剂量为80～160 mg／d。原西罗莫司联合霉酚酸酯和激素“三联”免疫抑制方案不变，根据西罗莫司目标浓度6～10 ng／mL（ ELASA方法）调整西罗莫司剂量；霉酚酸酯750 mg，2次／d，根据霉酚酸酯AUC 0－12水平（35～45 mg＆#183; h／L）调整剂量。疗效评估包括：①完全缓解，尿蛋白下降＞50％；②部分缓解，尿蛋白下降20％～50％；③无效，尿蛋白下降＜20％。结果随访12个月，2组患者的尿蛋白水平均显著下降，雷公藤组和缬沙坦组总有效率分别为96．3％和92．0％，雷公藤组尿蛋白下降较比缬沙坦组更加明显（ P＜0．01）。雷公藤组总胆固醇和三酰甘油水平均明显低于缬沙坦组（ P＜0．05）；缬沙坦组总胆固醇和三酰甘油水平有所升高，分别为[（6．60±0．22）mmol／L vs （7．11±1．13）mmol／L]和[（2．47±1．48）mmol／L vs （2．49±0．32）mmol／L]。雷公藤组血清清蛋白水平明显高于缬沙坦组[（41．1±1．2）g／L vs （37．9±4．2Objective Sirolimus （ SRL） is a potent immunosuppressive drug used to prevent acute allograft rejection after re-nal transplantation.Nevertheless, the occurrence of proteinuria has recently been recognized among patients treated with SRL-based therapy.The aim of this study was to investigate the therapeutic effect of tripterygium wilfordii hook F （ T II） on proteinuria caused by SRL in renal transplant recipients who were treated by trilogy immunosuppressive therapy of sirolimus combined with mycophenolate and hormone. Methods 52 recipients were divided into 2 groups randomly：TⅡgroup （n=27） and valsartan group （n=25）.The TⅡgroup was administered 1 mg/kg/d, and the valsartan group 80-160 mg/d for consecutive 12 months.Based on primary trilogy immu-nosuppressive therapy of sirolimus combined with mycophenolate and hormone, the dosage of sirolimus was adjusted according to the target concentration 6-10 ng/ml（ ELASA approach） and mycophenolate was administered 750 mg twice per day, adjusting dosage ac-cording to the mycophenolate AUC 0-12 level（35-45 mg＆#183; h/L）.The evaluation of therapeutic effect includes： complete remission, proteinuria decreased by＆gt;50%; partial remission, proteinuria decreased by 20% to 50%; ineffective, proteinuria decreased by320%. Results During the 12 month follow-up, the total effective rates in the TⅡgroup and the valsartan group were 95.2%and 86.7%respectively, in which the TⅡ group decreased more significantly （P30.01）.The total cholesterol level and triglyceride level in TⅡgroup were obviously lower than those in valsartan group（P30.01）.＆amp;nbsp;The total cholesterol level and triglyceride level in valsartan group increased （[6.60＆#177;0.2]mmol/L vs [7.11＆#177;1.13]mmol/L, [2.47＆#177; 1.48]mmol/L vs [2.49＆#177;0.32] mmol/L）.The serum protein level in TⅡ group was obviously higher than that in valsartan group （[41.1＆#177;1.2]g/L vs [37.9＆#177;4.2]g/L, P30.05）.At 3 month, 6 month and 12 month follow-up, the ave

关 键 词：肾移植 西罗莫司 蛋白尿 雷公藤多甙 

分 类 号：R699[医药卫生—泌尿科学]