不同免疫抑制剂所致肾移植受者血脂水平变化的比较

Blood lipid level changed by immunosuppressive drugs in renal transplantation recipients

目的 探讨不同免疫抑制剂对肾移植患者术后血脂变化的影响。方法肾移植术后患者283例，分别选择他克莫司（FK506），环孢素（CsA）和西罗莫司（SRL）免疫抑制剂治疗方案，比较不同免疫抑制剂患者移植前及术后不同时段血清总胆固醇（TC）和三酰甘油（TG）浓度差异。结果FK506组93例患者服药前与服药后96周血清TC和TG浓度分别为（4．9±1．1）、（1．4±0．8）mmol／L与（4．9±1．1）、（1．4±1．0）mmol／L，差异无统计学意义（P〉0．05）。CsA组106例患者分别为（4．8±1．0）、（1．6士0．8）mmol／L与（6．6±1．7）、（3．2±1．0）mmol／L，差异有统计学意义（P〈0．01）。CsA组和SRL组患者血清TC和TG浓度一般于服药后12～24周时开始升高。51例服用12周CsA后改为FK506，患者改药前及改药后72周血清TC和TG浓度分别为（6．7±1．1）、（2．8±1．0）mmol／L与（4．7士1．7）、（1．5±1．1）mmol／L，差异有统计学意义（P〈0．01）。结论脂质紊乱是肾移植患者非免疫因素引起慢性排斥反应和慢性移植物失功的重要原因，CsA和SRL是引起肾移植患者术后血脂增高的主要因素之一。对于高脂血症肾移植患者免疫抑制剂应用可优先考虑FK506，避免SRL、CsA合用而加剧血脂升高。

Objective To compare the effects on blood lipid level by immunosuppressive drugs in renal transplantation recipients. Methods Two hundred and eighty-three renal allograft recipients with tacrolimus （FK506）, cyclosporine A （CsA） and rapamycin （SRL） immunosuppressive regimen were reviewed in this study. The variation of whose total cholesterol（TC） and triglyceride（TG） concentration in serum were compared before and after three immunosuppressive regimen. Results There was no significant difference in TC and TG before and after oral FK506 for 93 patients[（4.9±1.1） and （1.4±0.8）mmol/L vs （4.9±1.1） and （1.4±1.0）retool/L, respectively, P〉0.05]. The concentration of TC and TG from 106 patients with CsA[（4.8± 1.0） and （1.6±0. 8）mmol/L vs （6.6±1.7） and （3.2±1.0）mmol/L, respectively]and 29 patients with SRL was higher than those before taking drugs, P〈0.05. The concentration was increased after 12 to 24 weeks generally. The concentration of TC and TG of CsA from FK506 to tacrolimus for 51 patients]（6. 7±1.1） and （2. 8±1.0）mmol/L vs （4. 7 ± 1.7） and （1.5±1.1）mmol/L, respectively] were decreased after 12 weeks （P〈0.01）. Conclusions Primary factor of dyslipidemia was that CsA and SRL were used for patients post-renal transplantation, which should be regarded. The FK506-based immunosuppressive regimen should be recomended in renal transplantation patients who have a hyperlipidmia.