低剂量环孢素A与肾移植患者术后存活的关系

Low Dose of Cyclosporin A Administrated in Renal Transplantation Recipients and Its Relation with Survivals

目的探讨肾移植术后使用低剂量环孢素A(CsA)与肾移植患者术后存活的关系。方法60例行肾移植术的术后患者根据移植术后首次应用CsA剂量分为2组:常规剂量组32例和低剂量组28例。比较两组免疫抑制剂用量下血药浓度、急性排斥反应?肺部感染发生率和人/移植肾生存率。结果低剂量组术后2、4周CsA平均血药浓度明显低于常规量组(P<0.001),而在术后2、3、6、12个月CsA平均血药浓度两组间差异均无统计学意义(P均>0.05)。常规剂量组和低剂量组在移植术后12个月内总的急性排斥反应发生率分别为9.4%、10.7%,两组间差异无统计学意义(P>0.05)。常规剂量组术后12个月内急性肺部感染发生率为34.4%,而低剂量组为10.7%,两组间差异有统计学意义(P<0.01)。常规剂量组2年肾移植人/肾生存率为93.8%/90.6%,而低剂量组为92.9%/89.3%,两组比较,差异无统计学意义(P>0.05)。结论低剂量环孢素A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,有利于提高肾移植患者的术后存活。

Objective To Investigate the influence of low dose cyclosporine A （CsA） on the recipients survivals after renal transplantation. Methods Sixty patients were divided into two groups： conventional dose group （n=32） and low dose group （n=28）. The dose and blood drug chroma of cyclosporine A at 2,4 weeks, 2,3,6 and 12 months posttransplantation. The incidences of acute rejection, pulmonary infection and patient/graft survival rate were compared between two groups. Results The dose of CsA in the low dose group was significantly lower than that in conventional dose group at 2 and 4 weeks posttransplantion（P〈0.001）. There was no effective difference after 2, 3, 6, 12 months posttransplantion （P〉0. 05）. During the first 12 months after transplantation, The conventional dose group＇s acute rejection occurred patients and the low dose group＇s patients （9.4% vs 10.7%）（P〉0.05）, Pulmonary infection had a signifi- cantly higher occurrence in the conventional dose than in the low dose group （34.4% vs 10.7%） （P〈0.01）. After 24 months, patients survival rate and the graft survival rate was no significant difference between the conventional dose and in the low dose （93.8%/90.6% vs 92.9%/89.3%） （P〉0.05）. Conclusion The low dose of CsA after renal transplantation could an significantly reduce the pulmonary infection and without increasing the incidence of acute rejection.