西罗莫司联合常规免疫抑制方案治疗慢性移植物肾病的近期疗效  

Effect of combination therapy of sirolimus and conventional immunosuppressive therapeutic schedule on chronic allograft nephropathy

作　　者：赵德威[1] 周伊娜 高小民 林斌伟[1] 夏鹏[1] Zhao Dewei Zhou Yina Gao Xiaomin Lin Binwei Xia peng.(Department of Kidney Transplantation, First Affiliated Hospital of Wenzhou medical University, Wenzhou 325000, China)

机构地区：[1]温州医科大学附属第一医院移植科,325000

出　　处：《中华移植杂志（电子版）》2016年第4期178-181,共4页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的探讨西罗莫司联合常规免疫抑制方案治疗慢性移植物肾病(CAN)的安全性和有效性。方法回顾性分析1999年9月至2014年9月在温州医科大学附属第一医院肾移植术后发生CAN并采用西罗莫司联合常规免疫抑制方案治疗的56例患者资料。观察西罗莫司联合治疗前及治疗后1、3、6、12个月血清肌酐、肾小球滤过率、肝功能、血脂、血常规和尿常规等结果,观察联合治疗1年内急性排斥反应、感染和移植肾失功等发生情况。采用重复测量资料方差分析比较西罗莫司联合治疗前、后各时间点血清肌酐和肾小球滤过率。P<0.05为差异有统计学意义。结果截至2015年12月,56例CAN患者接受西罗莫司联合治疗方案后平均随访时间(24±11)个月。西罗莫司联合治疗前患者平均血清肌酐和肾小球滤过率分别为(134±57)μmol/L和(61±21)m L/min,联合治疗后血清肌酐下降,肾小球滤过率上升。联合治疗后3、6、12个月与联合治疗前相比,差异均有统计学意义(P均<0.05);56例患者联合治疗后12个月均未发生急性排斥反应、感染、死亡及移植肾失功。6例患者联合治疗前已出现新发恶性肿瘤,联合治疗后肿瘤未见明显转移或病情进展;其余患者未见新发恶性肿瘤。新发高脂血症35例,经对症治疗后缓解。无新发肝功能异常和新发血糖异常患者。结论西罗莫司联合常规免疫抑制方案治疗CAN患者是安全、有效的,可以改善移植肾功能,但需要注意患者血脂变化。Objective To investigate the safety and validity of combination therapy of sirolimus and conventional immunosuppressive therapeutic schedule on chronic allograft nephropathy（ CAN）.Methods Clinical data of 56 recipients who developed CAN after getting renal transplantation during September 1999 to September 2014 in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. The indexes of serum creatinine,glomerular filtration rate,liver function,blood lipid,blood routine examination and urinalysis were observed before and 1,3,6,12 months after combination therapy. The occurrence of acute rejection,infection and graft dysfunction were also observed one year during combination therapy. Results The mean follow-up time after getting combination therapy was（ 24 ± 11） months. The mean serum creatinine and glomerular filtration rate of the 56 CAN recipients was（ 134 ± 57） μmol/L and（ 61 ± 21） m L/min before getting combination therapy,after combination therapy,the serum creatinine of them decreased and glomerular filtration rate increased,and the difference between before and 3,6,12 months after combination therapy showed statistically significant（ P all〈 0. 05）. No acute rejection,infection,death and graft dysfunction were occured in the above recipients one year after combination therapy. Six cases had new-onset malignant tumor before combination therapy,no tumor metastasis and progression were observed after combination therapy. The rest of the recipients did not develop new malignant tumor. Thirty-five recipients had newonset hyperlipidemia,which relieved after symptomatic treatment. No new case of abnormal liver function and pathoglycemia was observed. Conclusions The combination therapy of sirolimus and conventional immunosuppressive therapeutic schedule for CAN was safe and effective, and couldimprove the function of transplant kidney. However,the change of blood lipid should be noted.

关 键 词：肾移植 西罗莫司 钙调磷酸酶抑制剂 慢性移植物肾病 联合治疗 

分 类 号：R699.2[医药卫生—泌尿科学]