肾移植后新发糖尿病患者的免疫抑制方案转换

Conversion from Tacrolimus to cyclosporine A in renal transplantation recipients with NODAT

目的探讨将他克莫司（Tac）转换为环孢素（CsA）在改善肾移植后新发糖尿病（new onset diabetes after transplantation，NODAT）中的有效性和安全性。方法回顾分析45例同种异体肾移植术后NODAT患者（免疫抑制方案为Tac＋吗替麦考酚酯＋强的松），32例将Tac转换为CsA（转换组），13例未行转换（对照组），2组糖代谢指标及相关临床指标的变化情况。结果转换后1年，平均空腹血糖（FPG）由8．2±2．7mmol／L降至5．9±1．2mmol／L（P〈0．01），糖化血红蛋白（HbAlc）由（7．0±0．9）％降至（6．1±0．7）％（P〈0．05）；转换组FPG、HbAIe均较对照组低（P〈0．05）；NODAT的治愈率在转换组为53．1％（17／32），对照组为0％；药物转换后未发生急性排斥反应，肾功能无明显变化，1年人／肾存活率为100％，血压和血脂水平维持稳定。结论将Tac转换为CsA，对改善NODAT是安全有效的。

Objective To discuss the efficiency and safety of conversion from tacrolimus（Tac）to cyclos- porine A（CsA）in patients with new onset diabetes after transplantation（NODAT）. Methods The glucose me- tabolism parameters and related clinical indicators in 45 Tac treated renal transplantation recipients who developed NODAT were retrospectively analyzed. The oral immunosuppressive strategy was Tac ＋ mycophenolate mofetil （MMF） ＋ prednisone（Pred）. Results 32 cases were converted to CsA whereas 13 patients stuck to Tac. After conversion, fasting plasma glucose （FPG） decreased from （ 8.2 ± 2. 7 ） mmol/L to （ 5.9 ± 1.2 ） mmol/L （ P 〈 0. 01 ） and HbA1 c level decreased from（7.0± 0. 9）% to （6. 1 ± 0. 7） % （P 〈 0. 05 ）. The level of FPG and HbA1 c was lower in the conversion group than in the control group（P 〈 0. 05）. During the 1-year follow-up, the curative rate of NODAT was 53.1% （17/32） in the conversion group while it was 0% in the control group. No acute rejection happened after the conversion. There was no obvious change in renal function. The 1-year survival rate of patient and the transplanted kidney was 100%. Blood pressure and lipid levels were stable after the conversion. Conclu- sion Conversion from Tac to CsA is a simple and effective strategy to improve glucose metabolism in renal trans- plantation recipients with NODAT.