肾移植患者环孢素A肝毒性作用的回顾性研究

Retrospective analysis of the hepatotoxicity effect of Cyclosporine A in renal transplant patients

目的 :了解环孢素 A在肾移植患者肝功能受损中的作用和长期服用对患者的影响。方法 :回顾性分析了 3组资料 :(1) 1978年 7月至 1984年应用二联免疫抑制治疗 (硫唑嘌呤 +泼尼松 )的肾移植患者 83例 ,1985～ 1991年应用三联免疫抑制治疗 (环孢素 A+硫唑嘌呤 +泼尼松 )的肾移植患者 5 80例 ;(2 ) 1994年 1月至 1997年 8月进行的肾移植患者 5 19例 ;(3)随访服用环孢素 A免疫抑制治疗 8年以上患者 6 8例 ,10年以上 32例。结果 :(1)二联免疫抑制治疗组肝功能受损发生率为 14.5 % (12 / 83) ,三联免疫抑制治疗组为 2 6 .0 % (15 0 / 5 80 ) ,两者比较有明显差异 (χ2 =5 .114,P<0 .0 5 ) ,表明三联免疫抑制治疗发生肝功能受损的比例高于二联免疫抑制治疗 ;(2 ) 5 19例肾移植患者中发生肝功能严重损害 30例 (5 .8% ) ,有 HBV、HCV感染者 2 8例 ,占 93.3% (2 8/ 30 )。其中血清 HBs Ag阳性 11例 (36 .6 % ) ,HCV RNA阳性 12例 (4 0 % ) ,HBs Ag和 HCV RNA均阳性 5例。 (3)随访服用环孢素 A8年以上的 10 0例患者中 ,仅发现 1例肝硬化患者。结论 :环孢素 A具有一定的肝毒性 ,一般程度较轻 ,经调整用药后容易恢复。但环孢素 A在 HBV、HCV感染的基础上易加重肝脏的损害。长期服用环孢素 A较为安全 ,且免疫抑制效果稳?

Objective:To study the effect of hepatotoxicity of cyclosporine A and its influence on renal transplant patientsduring long term medication.Methods:(1) From August 1978 to February 1991, 663 cases of renal transplantation were done in our hospital. One hundred and sixty two cases developed liver damage (12 cases in 83 cases received bigeminy immunosuppress therapy,150 in 580 received triad immunosuppress therapy).(2) From 1994 to 1997, five hundred and nineteen cases of renal transplantation were done in our hospital. Thirty cases developed severe liver dysfunction (5.8%,30/519). (3) One hundred cases who take cyclosporine A 8 years longer were attended.Results:(1) The incidence rate of liver damage in patients received bigeminy immunosuppress therapy was lower than in triad immunosuppress therapy. (2) HCV RNA was positive in 40% and HBsAg was detected in 36.6%, both were detected positive in 93.3% of the 30 patients with severe liver dysfunction.(3) One case developed cirrhosis in 100 attending patients who take cyclosporine A 8 years longer.Conclusion: The hepatotoxicity of Cyclosporine A and hepatitis virus infections are the main causes of liver damages in renal recipients. The hepatotoxicity of cyclosporine A are partially reversible after a proper treatment. Severe liver dysfunction directly affects the outcome of renal transplant recipients.HBV and HCV infection are the major causes of liver dysfunction in the recipients. It is safe to take cyclosporine A long term by renal transplant patients.