肾移植术后长期应用环孢素2332例的临床远期随访  

Long-term outcomes of kidney transplantation in 2332 patients under cyclosporine A

作　　者：黄森林[1] 于立新[2] 邓文锋[2] 苗芸[2] 付绍杰[2] 徐健[2] 杜传福[2] 王亦斌[2] 叶桂荣[2] 

机构地区：[1]南方医科大学 [2]南方医科大学南方医院器官移植科,广州510515

出　　处：《广东医学》2016年第6期904-908,共5页Guangdong Medical Journal

基　　金：国家自然科学基金资助项目(编号:81500573);全国大学生创新创业训练计划项目(编号:201412121029);南方医科大学南方医院院长基金项目(编号:20138011)

摘　　要：目的总结肾移植术后长期应用环孢素（CsA）的临床经验。方法分析接受首次肾移植、术后长期服用CsA并维持随访的受者2 332例。根据患者的年龄分为儿童组（〈18岁）27例,成人组（18-60岁）2 086例,高龄组（〉60岁）219例,计算所有患者及分组的排斥反应发生率和1、3、5、10年人、肾存活率,并以成人组为对照,分别与儿童组、高龄组进行上述指标的比较。统计长期服用CsA不良反应的发生率。结果所有患者、儿童组、成人组以及高龄组急性排斥反应（AR）发生率分别为17.0%、40.7%、17.1%、13.2%,慢性排斥反应（CR）发生率相应为13.2%、29.6%、13.4%、9.1%;1、3、5、10年人、肾存活率分别为：所有患者97.0%/96.7%、93.2%/86.2%、88.4%/82.7%、83.4%/65.4%,儿童组96.3%/96.3%、92.6%/85.2%、88.9%/81.5%、81.5%/63.0%,成人组97.5%/96.9%、93.4%/86.1%、88.9%/82.8%、84.0%/65.3%以及高龄组94.5%/94.1%、91.8%/87.2%、83.6%/82.2%、78.1%/66.2%。儿童组AR、CR发生率高于成人组（P=0.003,P=0.022）,但人/肾存活率与成人组比较差异无统计学意义（P=0.34,P=0.08）。高龄受者CR发生率低于成人组（P=0.035）,生存率低于成人组（P=0.009）,AR和移植肾存活率与成人组类似（P=0.074,P=0.28）。CsA的不良反应有：肝功能损害（16.5%）、肾中毒（17.7%）、高脂血症（17.4%）、高血压（32.8%）、糖代谢异常（13.2%）、牙龈增生（35.7%）以及多毛（24.1%）等。通过减少CsA剂量、免疫抑制剂联合用药、对症治疗等措施,多数患者症状消失或缓解。结论 CsA是一种安全、有效的免疫抑制剂,除可用于成人肾移植之外还可用于儿童及高龄受者。移植术前良好的HLA配型,CsA精准浓度调控以及联合用药有利于降低CsA剂量,从而减少CsA不良反应的发生。Objective To investigate the long- term efficacy and safety for cyclosporine A（ CsA） in renal transplant recipients. Methods A total of 2332 kidney recipients were divided into three groups（ 1） children（ 〈18 years of age）（ GI,n = 27）;（ 2） adults（ 18 to 60 ys）（ GII,n = 2 086）; and（ 3） elderly recipients（ 〉60 ys）（ GIII,n =219）; Information was obtained on acute rejection（ AR）,chronic rejection（ CR）,side effect,patient and graft survival at 1,3,5 and 10 years. Data were compared among the three groups,with GII as the control group. Results At a mean follow up time of 87. 2 months,incidences of AR / CR for all patients and within each group were 17. 0% /13. 2%,40. 7% /29. 6%（ GI）,17. 1% /13. 4%（ GII） and 13. 2% /9. 1%（ GIII）,respectively. Patient / graft survival at 1,3,5and 10 years were 97. 0% /96. 7%,93. 2% /86. 2%,88. 4% /82. 7% and 83. 4% /65. 4% for all recipients; 96. 3% /96. 3%,92. 6% /85. 2%,88. 9% /81. 5% and 81. 5% /63. 0% for GI; 97. 5% /96. 9%,93. 4% /86. 1%,88. 9% /82. 8% and 84. 0% /65. 3% for GII and 94. 5% /94. 1%,91. 8% /87. 2%,83. 6% /82. 2% and 78. 1% /66. 2% for GIII,respectively. Compared with GII,GI had higher AR and CR incidences（ P = 0. 003,P = 0. 022）,however,patient /graft survivals were similar（ P = 0. 34,P = 0. 08）. Compared with GII,CR incidence and patient survival were lower for GIII（ P = 0. 035,P = 0. 009）,but AR incidence and graft survival were similar between the two groups（ P = 0. 074,P =0. 28）. The major long- term side effects associated with CsA- based immunosuppression include hepatoxicity（ 16. 5%）,nephrotoxicity（ 17. 7%）,hyperlipidemia（ 17. 4%）,hypertension（ 32. 8%）,impaired glucose metabolism（ 13. 2%）,gingival hyperplasia（ 35. 7%） and hirsutism（ 24. 1%）,etc. Most adverse effects were alleviated or eliminated by dose minimization of CsA,combination with other immunosuppressant agents and symptomatic treatments. Conclusion CsA is an effective immunosuppressive agent that

关 键 词：肾移植 长期存活 环孢素 药物监测 治疗结果 

分 类 号：R699.2[医药卫生—泌尿科学]