慢性移植肾肾病患者使用他克莫司联合麦考酚吗乙酯替代环孢素为基础的免疫抑制剂方案的疗效分析

Clinical analysis of converting cyclosporine-based immunosuppressant regimen to tacrolimus with mycophenolate mofetil in renal transplantation patients with chronic allograft nephropathy

目的探讨应用以环孢素(cyclosporine,CsA)为基础免疫抑制剂的慢性移植肾肾病(chronic allograft nephropathy,CAN)患者转换为他克莫司(tacrolimus,FK506)联合麦考酚吗乙酯(mycophenolate mofetil,MMF)治疗的疗效及安全性。方法使用CsA为基础免疫抑制方案的CAN患者76例,转换为FK506+MMF,随访6个月,根据移植肾穿刺病理结果将患者分为伴有慢性排斥反应组(CR组,41例)和不伴有慢性排斥反应组(non-CR组,35例)。观察两组的疗效及不良反应。结果 CR组好转27例(66%),稳定9例(22%),无效5例(12%);non-CR组好转11例(31%),稳定15例(43%),无效9例(26%),CR组疗效优于non-CR组(P<0.05)。CR组和non-CR组转换后,24h尿蛋白定量均有所降低,高血压和高脂血症的病例数有所减少,而且未出现继发性高血糖、严重感染等不良反应。结论 CAN患者使用FK506+MMF替代CsA为基础的免疫抑制剂方案是安全有效的。

Objective To investigate the efficacy and safety of converting cyclosporine（CsA）-based immunosuppressant regimen to tacrolimus（FK506）plus mycophenolate mofetil（MMF）in renal transplantation patients with chronic allograft nephropathy（CAN）.Methods Seventy-six cases of CAN were followed up for 6 month,who converted to FK506＋MMF from CsA.All cases were divided into chronic rejection（CR）group（n =41）and non-CR group（n =35）according to the pathological results of transplanted kidney.The efficacy and adverse reaction were observed between the two groups.Results In CR group,the renal function were improved in 27 cases（66 %）,stable in 9 cases（22 %）and even worse in 5 cases（12 %）.In non-CR group,the renal function were improved in 11 cases（31 %）,stable in 15 cases（43 %）and even worse in another 9 cases（26 %）.The efficacy of immunosuppressant conversion in CR group was more obvious than that in non-CR group（P 0.05）.The amount of 24-hour urine protein excretion was reduced compared with the pre-conversion in both CR group and non-CR group.Compared with pre-conversion,the incidence of hypertension and hyperlipidemia were also reduced.There was no case with new onset post transplantation hyperglycaemia as well as with serve infection.Conclusion It suggests that converting to FK506＋MMF from CsA-based regimen is safe and effective in treating renal transplantation patients with CAN.