他克莫司和环孢素对无症状乙肝表面抗原阳性者肾移植预后的影响

Effects of tacrolimus and cyclosporine on the prognosis of kidney transplantation patients with asymptomatic positive hepatitis B surface antigen

目的:比较尿毒症病人中无症状乙肝表面抗原(HBsAg)阳性者肾移植术后应用环孢素和他克莫司的疗效及安全性。方法:84例无症状HbsAg阳性者肾移植术后分别应用环孢素+麦考酚吗乙酯+泼尼松(43例)和他克莫司+麦考酚吗乙酯+泼尼松(41例),对比观察肾移植后一年内两组的排斥反应发生率及逆转率、药物的毒副作用及移植术后感染发生率。结果:他克莫司组和环孢素组的人/肾存活率分别为100%/100%和95.3%/100.0%;急性排斥反应发生率分别为4.9%和20.9%(P<0.05);抗排斥的逆转率均为100%。两组的毒副作用比较,他克莫司组肝功能损害、高血压和高脂血症的发生率(9.8%、12.8%和9.8%)显著低于环孢素组(27.9%、30.2%和27.9%,P<0.05),但术后糖尿病的发生率却高于环孢素组(19.5%vs4.6%,P<0.05)。两组在术后感染的发生率方面未见显著性差异。结论:对尿毒症病人中HBsAg阳性者,肾移植术后应用他克莫司+麦考酚吗乙酯+泼尼松的疗效及安全性均优于环孢素+麦考酚吗乙酯+泼尼松。

Objective：To compare the efficacy and safety of tacrolimus and cyclosporine in treatment of patients with asymptomatic positive hepatitis B surface antigen（HBsAg） after kidney transplantation.Methods： Eighty-four patients with asymptomatic positive HBsAg were divided into tacrolimus group（n=41） and cyclosporine group（n=43）.They received tacrolimus or cyclosporine combined with mycophenolate mofetil and prednisone as immunosuppressive schemes after kidney transplantation.All patients were followed up for one year to observe the incidence of acute rejection and rate of reversion,one-year survival rate of patients or transplantated kidneys,impairment of liver function,glucose and lipid metabolism and incidence of infection and side effects.Results： The survival rates of patient and kidney were 100%/100% and 95.3%/100% in tacrolimus group and cyclosporine group in one year,respectively.The incidence of acute rejection was significantly lower in tacrolimus group than in cyclosporine group（4.9% vs 20.9%,P〈0.05）,and reversal rate of acute rejection in both groups after immunosuppressive treatment was 100%.The incidences of impairment of liver function（9.8% vs 27.9%）,hyperlipemia（12.8% vs 30.2%） and hypertension（9.8% vs 27.9%） were significantly lower in tacrolimus group than in cyclosporine group（P〈0.05）,but the incidence of diabetes（19.5% vs 4.6%） was significantly higher in tacrolimus group than in cyclosporine group（P〈0.05）.There was no significant difference in the incidence of infection between the two groups.Conclusion： Tacrolimus combined with mycophenolate mofetil and prednisone is more effective and safe than cyclosporine combined with mycophenolate mofetil and prednisone in treatment of patients with asymptomatic positive HBsAg after kidney transplantation.