肾移植患者用他克莫司替换环孢素A后的疗效及不良反应的回顾性分析

A retrospective analysis of the efficacy and adverse reactions for the renal transplant patients conversed from cyclosporine A to tacrolimus

目的研究肾移植患者用基础免疫抑制剂他克莫司替换环孢素A后的疗效与不良反应。方法收集他克莫司替换环孢素A的肾移植患者随访资料,使用SPSS17.0分析替换后1年内相关药源性疾病(DIDs)和急性排异反应(AR)的改善情况。结果肾移植患者用他克莫司替换环孢素A后的1年内,慢性爬行肌酐升高(CScr)者和AR者的血肌酐(Scr)及尿素氮(BUN)均逐渐下降,两者有显著性差异(P<0.05或P<0.01);药物性肝损伤(DILI)者的总胆红素(TB)和直接胆红素(DB)逐渐下降,并呈显著性差异(P<0.05或P<0.01),第12个月转氨酶(ALT)显著降低(P<0.05);牙龈增生(GO)现象停止。然而,空腹血糖(FBG)在第12个月显著升高(P<0.05)。结论使用环孢素A的肾移植患者,若发生环孢素相关的AR和(或)其所致DIDs,可用他克莫司替换,但需警惕换药所致的肾移植后新发糖尿病。

Objective To study the efficacy and adverse reactions for renal transplant patients conversed from cyclosporine A to tacrolimus.Methods The follow-up data of renal transplant patients conversed from cyclosporine A to tacrolimus were collected.The clinical therapeutic outcomes including drug induced diseases（DIDs）and acute rejection（AR）induced by cyclosporine A were analyzed during the first year after conversion with SPSS17.0 software.Results The levels of Scr and BUN were significantly decreased during the first year after conversion for renal transplant patients with CScr and AR（P〈0.05 or P〈0.01）.The levels of direct bilirubin（DB）and total bilirubin（TB）were also significantly lowed（P〈0.05 or P〈0.01）during the first year for drug-induced liver injury（DILI）patients.The average level of ALT was significantly decreased in 12 months after conversion（P〈0.05）.The complications of gingival overgrowth（GO）stopped with the medication replacement.However,the fasting blood glucose（FBG）level increased significantly in 12 months after conversion（P〈0.05）.Conclusion For renal transplant patients suffered from AR or the serious DIDs induced by cyclosporine A,conversion from cyclosporine A to tacrolimus could be considered.However,it should be aware of the high blood glucose or the new diabetes caused by tacrolimus.