他克莫司和环孢素A对肾移植后患者炎性细胞因子和血脂的影响

Effects of tacrolimus and cyclosporine A on inflammatory cytokines and blood lipid after renal transplantation

背景:环孢素A与他克莫司是肾移植后临床广泛应用的免疫抑制剂。目的:观察他克莫司和环孢素A对肾移植后炎性细胞因子和血脂的影响。方法:选择首次接受同种异体肾移植后患者112例,随机分为环孢素A组和他克莫司组,移植后分别给予环孢素A+吗替麦考酚酯+糖皮质激素三联疗法与他克莫司+吗替麦考酚酯+糖皮质激素三联疗法。结果与结论:他克莫司组的1年人/肾存活率、治疗逆转率高于环孢素A组(P<0.05),急性排斥反应发生率低于环孢素A组(P<0.05);移植后1个月及1年的血清白细胞介素2,6,8和血糖水平高于移植前(P<0.05),低于环孢素A组(P<0.05),血清白细胞介素4,10低于移植前(P<0.05),高于环孢素A组(P<0.05);移植后1个月的血清总胆固醇、三酰甘油和低密度脂蛋白胆固醇高于移植前(P<0.05),但低于环孢素A组(P<0.05);移植后1年的血清总胆固醇和低密度脂蛋白胆固醇低于环孢素A组(P<0.05)。说明他克莫司可通过抑制肾移植后炎性细胞因子释放,改善糖脂代谢等途径降低患者的排斥反应,提高肾移植的存活率。

BACKGROUND：Tacrolimus （FK506） and cyclosporine A （CsA） are widely used immunosuppressive agents after renal transplantation in the clinic. OBJECTIVE：To investigate the effects of FK506 and CsA on inflammatory cytokines and blood lipid after renal transplantation. METHODS： Totally 112 patients who received renal allograft for the first time were randomly divided into two groups.The CsA group received a triple therapy of CsA, mycophenolate mofetil and glucocorticoid.The FK506 group received a triple therapy of FK506, mycophenolate mofetil and glucocorticoid.1-year survival rate, reversing rate, serum concentrations of interleukin （IL）-2, IL-4, IL-6, IL-8, IL-10, fasting plasma glucose and blood lipid were measured in the FK50 and CsA groups. RESULTS AND CONCLUSION： In the FK506 group, 1-year survival rate and reversing rate were significantly higher, while acute rejection rate was significantly lower, compared with the CsA group （P 0.05）. In the FK506 group, serum concentrations of IL-2, IL-6, IL-8 and fasting plasma glucose at 1 month and 1 year after transplantation were significantly higher compared with before transplantation （P 0.05） and CsA group （P 0.05）. In the FK506 group, serum concentrations of IL-4 and IL-10 at 1 month and 1 year after transplantation were significantly lower compared with before transplantation （P 0.05）, but significantly higher compared with the CsA group （P 0.05）. In the FK506 group, total cholesterol, triacylglycerol and low density lipoprotein cholesterol at 1 month after transplantation were significantly higher compared with before transplantation （P 0.05）, but were significantly lower compared with the CsA group （P 0.05）. In the FK506 group, total cholesterol and low density lipoprotein cholesterol at 1 year after transplantation were significantly lower compared with CsA group （P 0.05）. These findings suggest that FK506 may reduce acute rejection and increase survival rate of renal transplantation via inhibiting the release of cytokines and improving glucose and lipid metabolisms.A