骁悉、环孢素A和泼尼松在肾移植受者联合应用中最适剂量探讨  

Dose optimization of mycophenolate mofetil combined with cycloprine A and prednisone in renal transplant recipients

作　　者：吴建永[1] 陈江华[1] 王逸民[1] 何强[1] 吴东波[1] 

机构地区：[1]浙江大学医学院附属第一医院肾脏病中心,杭州310003

出　　处：《中华肾脏病杂志》2004年第2期132-135,共4页Chinese Journal of Nephrology

摘　　要：目的探讨国人肾移植后骁悉(MMF)、环孢素A(CsA)和泼尼松(Pred)联合应用的最适剂量。方法比较常规剂量组(104例)和低剂量组(96例)患者肾移植术后免疫抑制剂用量和急性排斥反应、肺部感染发生率和人/移植肾生存率。结果MMF和CsA用量在术后3个月、Pred用量在术后6个月内常规剂量组明显高于低剂量组。常规剂量组在6个月内包括活检证实、临床推断和亚临床排斥,其总的急性排斥发生率为17.3%,而低剂量组为19.8%,两组间差异无显著性意义(P=0.55)。两组患者在6个月内肺部感染发生率分别为40.4%和11.5%(P<0.0001),尤其是重症肺部感染发生率常规剂量组明显要高(26.9%比5.2%,P<0.0001)。两组患者人/肾1年生存率分别为87.4%/85.5%和97.9%/96.9%(P均<0.01)。排除感染所致的带功死亡后两组患者人/肾1年生存率差异无显著性意义。结论低剂量MMF、CsA和Pred联合应用并不增加急性排斥率、亚临床排斥发生率、排斥治疗逆转率和排斥反应的严重程度,但明显降低肺部感染发生率和病死率。Objective To optimize immunosuppressive dose of combined treatment with mycophenolate mofetil(MMF), cyclosporine A(CsA) and prednisone(Pred) in renal transplantation recipients. Methods According to the dose of triple combined immunosuppressive regimen, 200 patients were divided into conventional dose group(n=104) and low dose group(n=96). The dose of immunosuppressive regimen at 2 weeks, 4 weeks, 2 months, 3 months and 6 months posttransplantation,the incidences of acute rejection, pulmonary infection and patient/graft survival rate were compared between two groups. Results The dose of MMF, CsA and Pred in the low dose group was significantly lower than that in conventional dose group at 3 and 6 months posttransplantation. During the first 6 months after transplantation, acute rejection including biopsy proven, clinical presumed and subclinical acute rejection occurred in 18 of 104 patients(17.3%) in the conventional dose group,and in 19 of 96 patients(19.8%) in the low dose group(P >0 05). At 6 months posttransplantation, pulmonary infection, especially severe pulmonary infection, had a significantly higher occurrence in the conventional dose than in the lose dose group (40.4%vs 11.5%and 26.9%vs 5.2%respectively, P< 0.0001). At 12 months, patient survival rate was 87.4%and 97.9%(P< 0 01), while the graft survival rate was 85.5%and 96.9%(P< 0 01) in the conventional dose group and low dose group respectively. Excluding the death caused by infection with normal renal function,no significant difference was noted between two groups(P=0.68). Conclusion The low dose combination of MMF, CsA and Pred after renal transplantation can significantly reduce the pulmonary infection and mortality without increasing the incidence and severity of acute rejection and subclinical rejection.

关 键 词：骁悉 环孢素A 泼尼松 肾移植 剂量 MMF CsA 免疫抑制剂 肾病 

分 类 号：R699[医药卫生—泌尿科学]