西罗莫司对肝移植术后肾功能和血脂的影响

Influence of sirolimus on renal function and blood lipid after liver transplantation

目的探讨原发性肝细胞癌(肝癌)肝移植患者术后使用西罗莫司(sirolimus)对肾功能和血脂的影响。方法 56例肝癌肝移植患者分为两组。研究组(33例)采用西罗莫司+小剂量他克莫司(FK506)+肾上腺皮质激素(激素)方案,对照组(23例)采用FK506+激素方案。动态监测两组患者术前,术后1、3、6、9、12个月的血清肌酐(Scr)、血清总胆固醇、甘油三酯及高密度脂蛋白的变化情况,分别行组内不同时点比较和同时点组间比较。结果术前两组患者的Scr水平差异无统计学意义(P>0.05),术后9个月时的Scr比较差异有统计学意义(P<0.05),研究组的Scr水平低于对照组,且研究组术后Scr呈先升高再降低的变化趋势,对照组Scr呈缓慢上升的趋势。术前两组患者的血脂水平相当(P>0.05)。两组患者术后1个月的甘油三酯水平,术后6个月时的总胆固醇水平和高密度脂蛋白水平比较差异有统计学意义(P<0.05),研究组均高于对照组。两组患者未发现与高脂血症相关的心脑血管疾病。结论西罗莫司是一种低肾毒性的免疫抑制剂,与小剂量的FK506合用时可以减少FK506的肾毒性。西罗莫司的主要的不良反应是高脂血症。

Objective To investigate the influence of sirolimus administration on renal function and blood lipid after orthotopic liver transplantation（OLT）.Methods Fifty-six patients of hepatocarcinoma undergoing OLT were divided into two groups.The immunosuppression regimen of sirolimus,dose-decreased tacrolimus（FK506）and adrenal cortex hormone（hormone）were applied in experiment group（n=33）.And FK506 and hormone were applied in control group（n=23）.Serum creatine（Scr）and blood lipid indexes such as cholesterol（CH）,triglycerides（TG）and high-density lipoprotein cholesterol（HDL-c）were measured at pre-transplantation and 1,3,6,9,12 months after transplantation.The indexes were compared in different time points of one group and between different groups at the same time point.Results There was no significant difference in Scr level between the two groups before transplatation（P0.05）.And 9 months after OLT,there was significant difference in Scr level between the two groups（P0.05）.The Scr level of the experiment group was lower than that of the control group.The Scr level in the experiment group went up at first and then stepped down,while that in the control group increased gradually.There was no significant difference in blood lipid level between the two groups before transplantation（P0.05）,but significant differences was observed in TG level between the two groups 1 month after OLT（P0.05）.There were significant differences in level of CH and HDL-c between the two groups 6 months after OLT（P0.05）.The lipid level of experiment group was higher than the control group.No heart and brain events associated with hyperlipemia were observed in the two groups.Conclusions Sirolimus is an immunosuppressant with low renal toxicity.This study suggests that sirolimus combined with dose-decreased FK506 may have beneficial effects on renal function.Hyperlipemia may be the major side effect of sirolimus.