神经钙蛋白阻滞剂转换雷帕霉素治疗慢性移植肾肾病临床观察

Effect of conversion from calcineurin inhibitors to rapamycin on chronic allograft nephropathy

目的:探讨将神经钙蛋白阻滞剂转换为雷帕霉素治疗慢性移植肾肾病的临床疗效和安全性。方法:32例慢性移植肾肾病患者在确诊后将神经钙蛋白阻滞剂(CNI,包括CsA或FK506)转换为雷帕霉素(试验组),与同期未作调整的19例患者进行比较(对照组)。随访6个月,观察两组患者移植肾功能、蛋白尿、血压、血脂、肝功能、血象及急性排斥反应的发生情况。结果:试验组患者的血肌酐显著下降(P<0·05);对照组患者的肾功能继续恶化,两组比较差异有显著性统计学意义(P<0·05)。试验组患者蛋白尿、血脂显著增加,血红蛋白显著下降(P<0·05),两组比较差异有显著性统计学意义(P<0·05);其他指标比较差异无统计学意义。结论:将神经钙蛋白阻滞剂转换为雷帕霉素治疗慢性移植肾肾病安全有效,转换后引起的蛋白尿增加、高血脂和血红蛋白下降问题有待进一步研究。

Objective： To study the effect and safety of conversion from calcineurin inhibitors to rapamycin in kidney transplantion recipients with chronic allograft nephropathy. Methods： A total of 51 kidney transplant recipients with chronic allograft nephropathy were studied. 32 recipients（ test group）were administered with rapamycin after discontinue of calcineurin inhibitors （ CsA or FKS06）. The doses of CNI in another 19 recipients（control group） were not changed. Renal function, proteinuria, blood pressure, blood fat, hepatic function, hemogram and acute rejection were observed for six months in each group. Resuits： Serum creatinine dropped significantly in test group （ P 〈 0.05 ） while increased in control group. There was no significant difference in serum creatinine between two groups（P 〈0.05）. Test group showed increased proteinuria, serum cholesterol, triglycerides （ P 〈 0. 05 ）, and reduced hemoglobin （ P 〈 0. 05 ）. There was no significant difference in these indexes between two groups at six months postdose（P 〈0.05）. No significant differences were found in other indices in both groups. Conclusion： It is safe and effective for patients with chronic allograft nephropathy to convert from calcineurin inhibitors to rapamycin. However, the problem of increased proteinuria, blood fat and reduced hemoglobin need further research.