不同免疫抑制剂对肾移植术后孕妇发生妊娠期高血压的临床分析  

Clinical analysis of the incidence of pregnancy induced hypertension in pregnant women after renal transplantation with different immune inhibitors

作　　者：吴玉仙[1] 周洋[1] 张夕[1] 党建红[1] 金志军[1] Yu-xian WU Yang ZHOU Xi ZHANG Jian-hong DANG Zhi-jun JIN(Department of Gynaecology and Obstetrics, Changzheng Hospital Second Military Medical University, Shanghai, 20000)

机构地区：[1]第二军医大学附属上海长征医院妇产科,上海200003

出　　处：《生殖与避孕》2016年第12期992-998,共7页Reproduction and Contraception

摘　　要：目的:探讨免疫抑制剂他克莫司和环孢素与肾移植术后孕妇妊娠期高血压疾病发生的关系。方法:共搜集了32例肾移植术后妊娠的患者并根据应用的免疫抑制剂类型分为他克莫司组和环孢素组,每组各16例,比较从肾移植术后到围产期间的血压、尿蛋白水平、血肌酐值、空腹血糖值和妊娠结局。结果:他克莫司组在妊娠早期和妊娠晚期的尿蛋白水平低于环孢素组,差异有极显著统计学意义(P≤0.001);环孢素组的8例患者在妊娠晚期尿蛋白>3 000 mg/L,而他克莫司组仅出现3例24 h尿蛋白>3 000 mg/L;他克莫司组的妊娠期舒张压显著低于环孢素组,差异有统计学意义(P=0.008);他克莫司组和环孢素组的妊娠期高血压发病率分别为18.8%和34.4%,先兆子痫的发病率分别为9.4%和25.0%,差异均有统计学意义。两组空腹血糖值及妊娠结局组间无统计学差异。结论:应用他克莫司孕妇的妊娠高血压疾病和先兆子痫发病率低于应用环孢素的孕妇。提示他克莫司是肾移植术后孕妇的优选免疫抑制剂。Objective： To investigate the relationship between the application of cyclosporine or tacrolimus and the morbidity of gestational hypertension in post-renal transplantation pregnant patients. Methods： A total of 32 post-renal transplantation pregnant patients were included, and divided into two groups according to the immunosuppressive agent： the cyclosporine group （n=16） versus the tacrolimus group （n= 16）. The data of blood pressure, urinary albumin, serum creatinine and pregnancy outcome were collected during the whole period from post-transplantation to perinatal phase. Results： At the first and third trimester of pregnancy, the proteinuria level of tacrolimus group was statistically significantly lower than that of the cyclosporine group （P〈0.001）; the proteinuria level of 8 in 16 patients from the cyclosporine group elevated to over 〉3 000 mg/L versus 3 in 16 patients from the tacrolimus group; the diastolic pressure during pregnancy period of patients from the tacrolimus group was statistically significant lower than that from cyclosporine group （P=0.008）; the morbidity of gestational hypertension of the tacrolimus group and the cyclosporine group was 18.8% and 34.4%, respectively, and that ofpre-eclampsia was 9.4% and 25.0%, respectively, both showed statistically a significant difference between the two groups. There was no statistically significant difference of pregnancy outcomes between the cyclosporine group and the tacrolimus group. Conclusion： The post-renal transplantation patients treated with tacrolimus displayed significantly lower morbidity of gestational hyperten- sion and pre-eclampsia than that of cyclosporine, suggesting that the tacrolimus is more favorable immunosuppressive therapy agent for post-renal transplantation gestational patients.

关 键 词：肾移植术后 妊娠 他克莫司 环孢素 妊娠期高血压疾病 

分 类 号：R714.246[医药卫生—妇产科学]