雷公藤多苷对移植肾长期存活率的影响

The Effect of Multiglycosides of Tripterygium Wilfordii in Allograft Kidney Transplantation

目的:探讨雷公藤多苷(TW)作为免疫抑制剂对肾移植患者长期存活率的疗效及副作用。方法:104例患者在肾移植术后采用TW+泼尼松(Pred)+环孢霉素(CsA)+硫唑嘌呤(AZa)免疫抑制剂治疗,48例患者在肾移植术后采用Pred+CsA+骁悉(MMF)免疫抑制剂治疗,就以下方面对两组患者进行观察比较:(1)术后5年内发生排斥反应及临界改变情况;(2)外周血白细胞下降、肝功能异常的发生率;(3)严重感染情况;(4)出现尿蛋白情况;(5)术后5年内肾功能变化情况及移植肾5年存活率。结果:5年内AZa+TW组急性排斥反应及临界改变的发生率较MMF组低,分别为11.5%、16.7%和4.8%、6.3%(P>0.05);GPT高于正常的发生率分别为7.7%、16.6%(P>0.05);外周血白细胞低于正常的发生率分别为0.96%、18.8%(P<0.01);严重感染的发生率分别为1.9%、18.8%(P<0.05),5年内出现蛋白尿的患者例数分别为17.3%、29.2%(P>0.05),两组移植肾5年存活率相似,分别为89.6%、85.4%(P>0.05)。结论:在肾移植术后应用CsA+Pred+AZa+TW免疫抑制方案是可行的,既可以使肾移植术后急性排斥反应减少,同时还能减少蛋白尿及慢性排斥反应的发生率下降,为国内提高移植肾长期存活率提供了一条新的途径。

Objective： To investigate the long - term immunosuppressive and side effect of multiglycosides of Tripterygium Wilfordii （TW）in aUograft kidney transplantation. Methods： 104 allograft kidney transplantation recipients re- ceived TW ＋ Pred ＋ CsA ＋ Aza therapy while the other 48 received Pred ＋ CsA ＋ MMF. After 5 - year observation the two groups were compared by the following： （1）biopsy - proved acute rejection or borderline change; （2）abnormal change of transaminase and white bleo：l cells counts; （3） serious infection; （4） proteinuria; （ 5 ） prognosis and the change of Cre. Results： The incidence of acute rejection and that of biopsy- proved borderline change of the MMF group are higher than the TW group （ 16.7 % vs 11.5 % and 6.3 % vs4.8 % ） （ P 〉 0.05 ）. There were more recipients presenting proteinuria （29.2 % vs 17.3% ）and GPT above normal in the MMF group （16.6% vs 7. 7% ） but the difference has no reaeched statistic significance. While incidence of serious infection （18.8 % vs 1. 9 % ） and WBC counts under normal level （18.8 % vs0.96 % ） are significantly high in the MMF group. The five - year prognosis of TW group and MMF group is resemble （89.6 % ： 85.4 % ） （P 〉 0.05）. Conclusion： It was effective to perform CsA ＋ Pred ＋ AZa ＋ TW protocol after renal transplantation, for having decreased acute rejection ration and proteinuria level. We concluded that it was a new Pathway to improve the long - term allograft survival ratio after renal transplantation.