肾移植术后免疫抑制剂联合应用的方案优化研究

Study on optimized application of immunosuppressive agents after renal transplantation

目的评价肾移植术后不同免疫抑制治疗方案的疗效和毒副作用。方法选择在医院肾移植中心行肾移植术的病例109例,随机分为A、B、C、D 4组,肾移植术后分别给予4种不同的免疫抑制治疗方案,A组:采用新三联免疫抑制治疗,即起始环孢素A(Cs A)与霉酚酸酯(MMF)和糖皮质激素(ST)联用(Cs A+MMF+ST)并维持;B组:西罗莫司(SRL)代替环孢素A治疗,即起始西罗莫司与霉酚酸酯和糖皮质激素联用(SRL+MMF+ST)并维持;C组:西罗莫司代替霉酚酸酯治疗,即起始起环孢素A与西罗莫司和糖皮质激素联用(Cs A+SRL+ST)并维持;D组;转换使用西罗莫司,即在患者术后3个月内采用A组三联免疫抑制方案,之后采用SRL置换Cs A组。观察术后9个月各组的全血白细胞、红细胞、中性粒细胞数量、肝功能、血清肌酐以及肌酐清除率的变化。结果治疗9个月后,各组的血液学指标没有统计学差异(P>0.05);而D组的肝功能、肌酐以及肌酐清除率优于其他3组(P<0.05)。结论肾脏移植术后给予西罗莫司置换免疫抑制治疗方案,对于患者的肝肾功能影响小。

Objective To evaluate the efficacy and side effects of immunosuppressive therapy after renal transplantation. Methods A total of 109 patients having received renal transplantation in hour hospital were randomly divided into groups A, B, C and D, and different immunosuppressive regimens were provided for them respectively. Group A： new triple immune suppression therapy is adopted, namely initial cyclosporine A （CsA） and mycophenolate mofetil （MMF） and glucocorticoid（ST） （CsA＋MMF＋ST）, and the therapy was maintained; group B： sirolimus （SRL） replaced CsA in the treatment, i.e. SRL＋MMF＋ST, and the therapy was maintained; group C： SRL replaced MMF, i.e. CsA＋SRL＋ST, and the therapy was maintained; Group D： SRL was adopted later, i.e., the triple immune suppression therapy for group A was adopted initially; three months later, SRL replaced CsA. The changes in whole blood white blood cells, red blood cells, neutrophils, liver function, serum creatinine and creatinine clearance rate in all group nine months after the operation were observed. Results After nine months＇ treatment, there was no significant difference in hematological indexes among all groups （P 〉 0.05）, and the liver function, creatinine and creatinine clearance rate in group D were better than those in the other three groups （P 〈 0.05）. Conclusion Sirolimus replacement immunosuppressive regimens for the patients after kidney transplantation has the smallest effect on the liver and kidney function of patients.