环孢素A和他克莫司对1型糖尿病肾移植受者血糖的影响

Effect of Cyclosporin A and Tacrolimus on Blood Glucose in Kidney Transplant Recipients with Type 1 Diabetes

目的观察和比较环孢素A与他克莫司对1型糖尿病肾移植受者血糖的影响,为1型糖尿病肾移植受者术后早期选择合理的免疫抑制剂提供参考。方法收集1型糖尿病肾移植受者40例,随机分为CsA组和FK506组。同种异体肾移植术后,CsA组予环孢素A(CsA)+吗替麦考酚脂(MMF)+强的松(Pred)行免疫抑制治疗,共20例;FK506组予他克莫司(FK506)+MMF+Pred行免疫抑制治疗,共20例。各组受者术前均用胰岛素控制空腹血糖(FBG)和糖化血红蛋白(HbA1c)至基本正常,术后降糖方案与术前相同。观察和比较两组肾移植受者术前和术后第1、3、6个月的FBG浓度和HbA1c含量。结果治疗的6个月内,CsA组有3例退出,FK506组有4例退出。CsA组和FK506组的FBG、HbA1c水平逐渐升高。CsA组的FBG在术后第6个月比术前显著升高(P<0.05),而CsA组HbA1c含量在术后各时间段与术前比较差异均无统计学意义(P>0.05)。FK506组FBG水平在术后第3、6个月比术前显著升高(P<0.05),FK506组HbA1c水平在术后第6个月比术前显著升高(P<0.05)。FK506组FBG水平在术后第3、6个月比CsA组显著升高(P<0.05),FK506组HbA1c水平在术后第6个月比CsA组显著升高(P<0.05)。结论 FK506对I型糖尿病肾移植受者术后早期升高血糖的影响比CsA大。

Objective To observe the effect of cyclosporine A（CsA） and tacrolimus（FK506） on blood glucose in kidney transplant recipients with type 1 Diabetes,thereby for kidney transplant recipients with type 1 Diabetes,providing a reference for the rational selection ofimmunosuppressants in the early stage of renal post-transplantation. Methods A prospective study for 6 months was conducted in 40 kidney transplant recipients with type 1 Diabetes,who were randomly divided into CsA group （n=20） and FK506 group（n=20）.CsA group was treated with CsA based immunosuppression,whereas FK506 group was treated with FK506 based immunosuppression after renal allotransplantation.Fasting blood glucose（FBG） and glycosylated hemoglobin（HbA1c） of each recipient using insulin was normal before operation,and the scheme of decreasing blood glucose before operation was the same as the one after operation. Results There were 3 patients in CsA group and 4 patients in FK506 group that withdrawed from the study.FBG,HbA1c in CsA group and FK506 group gradually increased after operation.In CsA group,FBG in the 6th month of postoperation significantly increased （P〈0.05）compared to that of preoperation,while HbA1c did not significantly increased（P〉0.05）after operation.In FK506 group,FBG in the 3th and 6th month of postoperation significantly increased（P〈0.05）compared to that of preoperation,and HbA1c in the 6th month of postoperation significantly increased（P〈0.05）compared to that of preoperation.FBG in FK506 group in the 3th and 6th month of postoperation was significantly higher（P〈0.05）than that in CsA group,and HbA1c in FK506 group in the 6th month of postoperation was significantly higher（P〈0.05） than that in CsA group.Conclusion FK506 is more prone than CsA to increase blood glucose of kidney transplant recipients with type 1 diabetes in the early stage of renal post-transplantation.