环孢素A和他克莫司对肾移植受者血脂的影响

Effects of cyclosporine A and tacrolimus on blood lipid of renal transplant recipients

背景:高血脂为肾移植后常见的并发症,常用的免疫抑制剂包括环孢素A,泼尼松和他克莫司都会对患者血脂产生影响。目的:探讨他克莫司与环孢素对肾移植术后患者血脂的影响。方法:按照不同的服药方案将肾移植后的患者随机分成2组:环孢素A组(n=20),免疫抑制剂方案为环孢素A+麦考酚酸莫酯+泼尼松;他克莫司组(n=23),免疫抑制剂方案为他克莫司+麦考酚酸莫酯+泼尼松。于移植前,移植后1个月及6个月对患者抽血化验,观察两组患者总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇的变化。结果与结论:两组各项指标移植前后比较均有差异,两组间比较,移植后1个月和6个月总胆固醇和低密度脂蛋白胆固醇差异显著(P<0.05);高密度脂蛋白胆固醇和三酰甘油之间差异不显著。结果表明:对肾移植后肾功能稳定的患者实施以环孢素A为免疫抑制剂的方案,三酰甘油和低密度脂蛋白胆固醇更易升高,他克莫司在脂类代谢方面表现出更少的不良反应。与环孢素A相比,肾移植后患者应用他克莫司高脂血症的发病率明显降低。

BACKGROUND：Hyperlipidemia following successful renal transplantation is a frequent and persistent complication.Several immunosuppressive agents, including cyclosporine A （CsA）, corticosteroids, and tacrolimus, appear to have a significant pathogenetic role.OBJECTIVE：To investigate the differential effects of tacrolimus and CsA on blood lipids in renal transplant recipients.METHODS：Renal transplant recipients treated with a different combination of immunosuppressive agents were divided into CsA（n=20） group, who received CsA＋mycophenolatemofetil （MMF）＋steroids and tacrolimus （n=23） group, who treated by tacrolimus＋MMF＋steroids.Plasma lipids, including total cholesterol, triglycerides, low-density lipoprotein cholesterol （C-LDL） andhigh-density lipoprotein cholesterol （C-HDL） were examined prior to, 1 and 6 months after transplantation.RESULTS AND CONCLUSION：There were statistically significant differences between the two groups prior to and after transplantation.Total cholesterol levels and C-LDL levels were significantly different when compared between the two groups at 1and 6 months after transplantation.The differences of C-HDL and triglycerides were not statistically significant.The results demonstrated that, triglycerides and C-LDL levels are prone to increase in renal transplant recipients received CsA therapy, and the hyperlipidemia is less pronounced in patients given tacrolimus.Compared with CsA, tacrolimus appears lower the attack rateof lipid metabolism.