四联低剂量免疫抑制方案在肾移植术后早期应用研究  

Quadruple low-dose immunosuppressant maintenance therapy protocol in renal transplanted recipients within three months after renal transplantation

作　　者：费爽[1] 王子杰[1] 陈浩[1] 孙黎[1] 陶俊[1] 韩志坚[1] 谭若芸 顾民[1] 居小兵[1] Fei Shuang;Wang Zijie;Chen Hao;Sun Li;Tao Jun;Han Zhijian;Tan Ruoyun;Gu Min;Ju Xiaobing(Department of Urology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院泌尿外科,210029

出　　处：《中华器官移植杂志》2020年第3期174-179,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金面上项目(81870512,81770751,81570676,81470981,81100532);江苏省"333"工程项目(BRA2017532,BRA2016514);江苏省"科教兴卫"工程医学重点人才培养资助项目(RC2011055);江苏省"333高层次人才培养工程"项目(2011,2013);江苏省"六大人才高峰"资助项目(2010WSN-56,2011-WS-033);江苏省卫生厅面上项目(H2009907)。

摘　　要：目的:观察肾移植术后早期(3个月内)转换成含西罗莫司的四联低剂量免疫抑制剂维持方案的有效性及安全性。方法:回顾性分析于2013年1月至2018年12月在南京医科大学第一附属医院行肾移植术,并在术后早期由三联免疫抑制剂方案转换为含西罗莫司在内的四联免疫抑制方案61例,对换方案前后受者的肾功能、肝功能、血脂、尿蛋白及不良反应等指标进行统计分析。结果:换方案后随访1年,受者血肌酐及尿素氮水平呈进行性下降(P<0.05);血红蛋白及血小板计数较转换前升高(P<0.05);血清胆固醇、甘油三脂、丙氨酸转氨酶转氨酶、天冬氨酸转氨酶、血钾及血钙水平较转换前有差异(P<0.05),以上差异均有统计学意义;而外周血白细胞计数及血钠水平在转换前后差异无统计学意义(P>0.05);换方案前后受者尿蛋白阴性比率有变化(转换前为44.26%,转换1年后为81.97%)。此外,换方案后随访1年内受者不良反应的发生率分别为:肺部感染24.59%,BK病毒(BKV)感染4.92%,移植肾动脉狭窄3.28%,急性排斥反应6.56%。结论:在受者肾移植术后早期转换为含西罗莫司的四联低剂量免疫抑制方案可有效改善移植肾功能,且未增加不良反应的发生风险。Objective To observe the efficacy and safety of quadruple low-dose immunosuppressant maintenance therapy of sirolimus(SRL),calcineurin inhibitors(CNIs),mycophenolate mofetil(MMF)and glucocorticoid in recipients switched within three months after renal transplantation.Methods This retrospective study recruited 61 recipients on quadruple immunosuppressive therapy within three months after renal transplantation from 2013 to 2018.The changes of serum creatinine(SCr),blood urea nitrogen(BUN),hemoglobin(HGB),white blood cell(WBC),platelet(PLT),liver function,fasting blood-glucose(FBG),serum lipid,electrolyte and urine protein before and after using this protocol were recorded.Results No significant difference existed between before and after protocol switching in WBC or serum sodium.But after protocol switching,significant differences could be observed in SCr,BUN,serum calcium,serum potassium,aspartate transaminase(AST),PLT,alanine transaminase(ALT),HGB,FBG,triglycerides(TG)and cholesterol(TC,P<0.05).Urine protein negative rate was 44.26%before switching.However,it was 81.97%after protocol switching.After switching during a 1-year follow-up period,the incidence of pulmonary infection rate was 24.59%,the incidence of BKV infection rate 4.92%,the incidence of transplant renal artery stenosis 3.28%and the incidence of acute rejection 6.56%.Conclusions Quadruple low-dose immunosuppression maintenance therapy of SRL,CNIs,MMF and glucocorticoid switched within 3 months after renal transplantation may be an effective and safe protocol of improving renal allograft function and enhancing recipient prognosis.

关 键 词：肾移植 免疫抑制剂 低剂量 

分 类 号：R699.2[医药卫生—泌尿科学]