肾移植早期快速激素减量安全性分析

Analysis of the safety of rapid adrenocortical hormone tapering after renal transplantation

目的观察肾移植受者早期快速激素减量的安全性。方法 108例肾移植受者,在含肾上腺皮质激素(激素)的常规三联免疫抑制方案的基础上,分别接受抗胸腺细胞免疫球蛋白(ATG)或抗CD25单抗诱导治疗,于肾移植术后1个月末泼尼松减量至5～10 mg/d。统计术后1、2和3年人/肾存活率,术后1年内的急性排斥反应发生率、移植后感染发生率;记录术后1、6、12个月泼尼松的用量及环孢素(CsA)、他克莫司(FK506)、麦考酚吗乙酯(MMF)的用量,随访期间监测血压、血清肌酐(Scr)、空腹血糖水平。结果受者术后1、2和3年人/肾存活率分别为98%/95%、96%/96%和93%/93%。术后1年急性排斥反应发生率为13%,移植后感染发生率为13.9%。术后12个月内,肾移植受者CsA、FK506、MMF平均用量呈下降趋势。术后1、3、6、12个月泼尼松用量分别为(9.26±2.11)mg/d、(7.42±2.20)mg/d、(6.15±1.94)mg/d、(6.24±2.18)mg/d。术后1年血清肌酐水平为(100±23)μmol/L,收缩压为(127±10)mmHg,舒张压为(81±6)mm-Hg,空腹血糖水平为(5.35±1.44)mmol/L。结论在小剂量抗体诱导、保证钙调磷酸酶抑制剂(CNI)目标浓度,保证机体处于足量免疫抑制的情况下,肾移植术后1个月内快速减少激素至5～10mg/d,移植肾功能正常稳定,同时有助于减少激素不良反应,减少移植后近期感染风险,安全性良好。

Objective To observe the safety in renal transplant patients treated with rapid adrenocortical hormone （corticosteroid） tapering. Methods One hundred and eight adult renal transplant recipients were treated with modern triple-therapy including ciclosporin （CsA） or tacrolimus （FK506） , mycophenolate mofetil （MMF） and corticosteroid after immunoinduction with antithymocyte globulin （ATG） or anti-CD25 monoclonal antibody. The dose of prednisone was reduced to 5-10 mg/d in the first month after transplantation. The 1, 2 and 3-year survival rates of patient/graft, the 1 -year graft acute reaction incidence as well as the incidence of infection post-transplantation was analyzed. The dose of prednisone, CsA, FK506 and MMF, serum creatinine （Scr） levels, blood pressure and fasting blood glucose levels were followed up at 1,6 and 12-month post-transplantation. Results The patient/graft survival rate at 1, 2 and 3 years after transplantation was 98%/95% , 96%/96% and 93% /93% respectively. The one-year acute rejection rate was 13% and infection rate was 13.9%. The average dose of CsA, FK506 as well as MMF was reduced gradually in the twelve- month post-transplantation. The dose of prednisone at 1, 3, 6 and 12-month was （9.26±2. 11 ） mg/d, （7. 42 ±2.20） mg/d, （6. 15 ± 1.94） mg/d and （6. 24 ±2. 18） mg/d respectively. The Ser level was （ 100 ±23）μmol/L, the systolic blood pressure was （127±10） mmHg, the diastolic blood pressure was （81±6） mmHg and the fasting blood glucose level was （5.35 ±1.44） mmoL/L in the fist year postoperation. Conclusion Rapid cortieosteroid tapering in renal transplant patients can reduce the incidence of eortieosteroid-related adverse reactions and infection while maintaining stable graft function.