硫唑嘌呤和霉酚酸酯对应用环孢素A肾移植患者血脂的影响

Changes of lipid indexes during azathioprine or mycophenolate mofetil therapy based on cyclosporine and steroids following renal transplantation

目的:肾移植术后环孢素A和皮质醇联合应用可使患者发生高脂血症的风险升高,观察在此基础上应用硫唑嘌呤和霉酚酸酯对肾移植患者血脂的影响。方法:选择2003-01/2006-01解放军第四军医大学西京医院泌尿外科收治的肾移植患者65例,患者均知情同意。①实验分组及方法:按服用免疫抑制剂不同将患者分为2组,硫唑嘌呤组35例,霉酚酸酯组30例。患者肾移植术后1年内均以环孢素A和皮质醇为基础免疫抑制治疗方案,免疫抑制方案始终为环孢素A+硫唑嘌呤+皮质醇或环孢素A+霉酚酸酯+皮质醇。②实验评估:检测两组患者术前、术后3个月、个月及12个月的血脂指标,包括总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密6度脂蛋白胆固醇和极低密度脂蛋白胆固醇,同时检测血清肌酐水平。结果:65例患者全部进入结果分析,无脱落。①术前患者高脂血症的发生率是35.2%,至术后第3个月为62.7%,术后第6个月为52.3%,术后第12个月为39.3%。②术后1年中两组患者的总胆固醇和三酰甘油水平均较术前显著升高(P<0.05),术后第3个月时霉酚酸酯组的总胆固醇水平显著高于硫唑嘌呤组(P<0.05),但在第6个月以后,两组间总胆固醇与三酰甘油水平差异无显著性意义(P>0.05)。在1年的监测中,两组患者的高密度脂蛋白、低密度脂蛋白和极低密度脂蛋白水平皆未发生显著变化(P>0.05)。结论:在以环孢素和皮质激素为基础免疫抑制方案的肾移植患者中,血清总胆固醇和三酰甘油有明显的升高倾向,而这种升高倾向可能与长期服用硫唑嘌呤或霉酚酸酯无关。

ATM： To compare the effects of azathioprine （AZa） versus mycophenolate mofetil （MMF） based on corticosteroid combined with cyclosporine, which may induce hyperlipidemia, following renal transplantation. METHODS： Sixty-five patients underwent renal transplantation were selected from Department of Urinary Surgery, Xijing Hospital, Fourth MilJtary Medical University of Chinese PLA between January 2003 and January 2006. The informed consent was obtained from the patients. ①AII subjects were divided into AZa group （n =35） and MMF group （n =30）, and they were treated by corticosteroid ＋ AZa ＋ cyclosporine and corticosteroid ＋ MMF ＋ cyclosporine, respectively within 1 year after renal transplantation. ②The lipid indexes including total cholesterol （TC）, triglyceride （TG）, high-density lipoprotein cholesterol （HDL-C）, low-density lipoprotein cholesterol （LDL-C）, and very low-density lipoprotein cholesterol （V＇LDL-C） were measured before, 3, 6 and 12 months after transplantation, respectively. Meanwhile, serum creatinine level was evaluated. RESULTS： Totally 65 patients were involved in the result analysis, with no loss. ①For all patients, the prevalence of hyperlipemia was 35.2% during the pretransplant period, 62.7% at month 3, 52.3% at month 6, and 39.3% at month 12 after renal transplantation. ②TC and TG levels were significantly increased in both groups in the first year （P 〈 0.05）. Three-month value for TC in MMF group was higher than that in AZa group （P 〈 0.05）. No significant difference was observed in these two indexes between two groups 6 months after transplantation. （P 〉 0.05）. In both groups, HDL-C, LDL-C, and VLDL-C levels did not change during the one-year monitor （P 〉 0.05）. CONCLUSION： Independent from hyperlipidemia risk factors, serum total cholesterol and triglycedde levels tend to increase during corticosteroid combined with cyclosporine therapy among patients undergoing renal transplantation, which has no relationship with MMF or AZa treatment for a long term.