肾移植慢性排斥的后期药物调整

Immunosuppresion adjustment in chronic rejection of renal transplantation

对２７例术后６个月～８年７个月发生慢性排斥的肾移植患者进行治疗，２１例经治疗后血清肌酐明显下降，并稳定，６例病情有反复。比较不同时期的免疫抑制剂用量，发现稳定组在慢性排斥发生后１、３、６个月时环孢素Ａ、强的松、硫唑嘌呤的用量均明显高于治疗前，而不稳定组在上述时期的免疫抑制剂用量不高于或低于治疗前。认为长期应用较大剂量的免疫抑制剂（尤其是环孢素Ａ）是维持慢性排斥治疗效果的关键，并应充分重视硫唑嘌呤的作用，而某些辅助用药可有效防治大剂量免疫抑制剂所带来的不良后果。

From Jan. 1989 to Apr. 1992, 43 renal graftrecipients with chronic rejection were treated, and 27 of them showed reversion. These 27 patients were classified into stable and unstable groups. It was found that the daseses of CsA, Pred and Aza in stable group in the first, third and sixth month after chronic rejection were obvinusly larger than those before the rejection and the dosages in unstable group were not as larg as before or even lower. It was indicated that larger doses of immunosuppressive drugs in long term were the key to the treatment of chronic rejection, and the attention should be paid to the effect of Aza. Some additive drug were effective for the adverse effects of large doses of immunosuppressants drugs.