肾移植术后应用FK506抗排斥治疗的临床研究

A Clinical study of the use of FK506 in renal transplant recipients

目的 观察ＦＫ５０６ 在肾移植术后抗排斥治疗的效果及副作用。 方法 对肾移植术后单独应用环孢素Ａ（ＣｓＡ）５０ 例和术后应用ＦＫ５０６ ５０ 例（ 术后２４ 小时应用ＦＫ５０６ ４０ 例，ＣｓＡ 中毒后改ＦＫ５０６ １０ 例）患者进行比较。 结果 ＣｓＡ 组发生急性排斥反应（ＡＲ）９ 例，发生率为１８ ％ ，逆转８ 例（８８ ％） ，肾功能在２ ～２６ 天恢复正常３８ 例（７６ ％） ，肺部感染２ 例，泌尿系感染１ 例，肾中毒２例，肝中毒３ 例，高血糖２ 例，腹泻１ 例，摘肾１ 例。ＦＫ５０６ 组ＡＲ４ 例均逆转，肾功能２～１３ 天恢复正常４０ 例（８０％ ），高血糖１４ 例（２８％ ），肾中毒２ 例，肝中毒１ 例，腹泻２２ 例（４４％ ），１ 例因肺部感染、高血糖难以控制仍改用ＣｓＡ。应用ＣｓＡ 肝中毒的１０ 例患者改用ＦＫ５０６ 后肝功能７ ～１６ 天全部恢复正常。 结论 肾移植术后应用ＦＫ５０６ 安全有效，排斥率明显降低，副作用小，但对长期存活的影响及并发症还需进一步观察。

Objective To study the effects and side effects of FK506 in renal transplant recipients. Methods 50 renal transplant recipients on FK506 were reviewed,in 40 of them FK506 being used immediately after transplantation and in 10 being converted from CsA to FK506 because of hepatoxicity.50 renal transplant recipients on CsA served as controls. Results In the CsA group,the renal function became normal in 2～26 days in 38 patients (76.0%).Acute rejection occurred in 9(18%),of them the renal function recovered in 8.Pulmonary infection occurred in 2,urinary infection in 1,renotoxicity in 2,hepatotoxicity in 3 (another 10 cases converted to the use of FK506 because of hepatotoxicity),hyperglycosemia in 2 and diarrhea in 1.Resection of the renal allograft was carried out in 1.In the FK506 group,the renal function became normal in 2～13 days in 40 patients(80.0%).Acute rejection occurred in 4,being all recovered on appropriate management,hyperglycosemia occurred in 14(28.0%),renotoxicity in 2,hepatotoxicity in 1 and diarrhea in 22(44.0%),In 1 patient,FK506 was conyerted back to CsA because of pulmonay infection and uncontrollble hyperglycosemia.In the 10 cases converted form CsA to FK506 bbecause of hepatotoxicity,the hepatic function recovered to normal in 7～16 days in all. Conclusions The use of FK506 is safe and effective in renal trnsplant recipients with less side effects.Its effects in long term survivals should be further studied.