他克莫司对肾移植后糖代谢的影响及其控制

The effect of tacrolimus on carbohydrate metabolism and controlling

目的 制定他克莫司 (FK5 0 6 )治疗窗浓度 ,并控制肾移植后糖尿病 (PTDM )的发生和发展。方法 对肾移植术后用FK5 0 6为基础的免疫抑制剂治疗的 2 0例受者 ,进行回顾性研究。结果 2 0例患者随访 1年 ,4例发展为糖尿病 ,发生率为 2 0 % ,患者发病前 4～ 8周都经受较高FK5 0 6浓度 ( 2 0～ 2 8μg/L)作用 ,经降低泼尼松 (Pred)用量、结合胰岛素替代治疗效果不佳 ,后经调整FK5 0 6浓度为 :第 1个月 5～ 15 μg/L ,第 2个月起 5～ 10 μg/L。 2例血糖完全恢复正常 ,另 2例因急性并发症转换为环孢素A(CsA)治疗。治疗期间无 1例出现急性排斥和血肌酐升高。结论 FK5 0 6具有强效免疫抑制作用 ,可防止急性排斥发生。在使用FK5 0 6期间 ,一旦发生PTDM ,可通过减少Pred用量 ,降低FK5 0 6浓度 ,同时使用胰岛素控制其发生、发展。如出现急性并发症 ,可将FK5 0

Objective To make a proper therapy window concentration of tacrolimus and to control the development of post transplantation diabetic mellitus (PTDM). Method The data of 20 renal allograft patients with tacrolimus-based regimen were retrospectively analyzed.Results After follow up for one year, 4 cases developed into PTDM with the incidence being 20?%. All patients had been under the high concentration of tacrolimus (20～28?μg/L) for 4～8 weeks before symptoms appeared. It was insufficient to control the blood sugar level by reducing prednisone dosage or adding insulin simply. By regulating the tacrolimus concentration, 2 cases recovered completely and 2 cases converted to cyclosporine based therapy because of acute complications. During follow up, no acute rejection episode occurred. Conclusions High level of tacrolimus can produce toxicity on islet cell. Once PTDM happened, it may be important to decrease prednisone dosage, combine insulin and down regulate the concentration of tacrolimus. CsA could be used again in the presence of acute complications.