肾移植术后激素早期撤除患者的随访观察

Follow-up of early steroid withdrawal therapy after kidney transplantation

目的探讨肾移植术后采用无肾上腺皮质激素(激素)免疫抑制方案的临床疗效及安全性。方法选择肾移植术后1年以上采用无激素免疫抑制方案的55例肾移植受者为激素早期撤除组,另选择同期60例常规使用激素免疫抑制方案的肾移植受者作为对照组。记录肾移植1年内2组肾移植受者的血糖、血脂变化以及术后感染、急性排斥反应(AR)发生情况,比较2组在肾移植术后1年的肾功能指标,对患者进行定期随访,观察术后2组肾移植受者及移植肾的存活情况。结果肾移植术后1年,激素早期撤除组肾移植受者的血糖、血脂水平及肺部感染发生率均低于对照组(P均<0.05),其尿蛋白水平高于对照组(P<0.001)。2组的血清肌酐、血尿素氮水平相近(P均>0.05),组间AR、心血管疾病、泌尿系统感染、消化系统感染及神经系统感染发生率比较差异亦无统计学意义(P均>0.05)。2组肾移植受者及移植肾的生存曲线比较差异均无统计学意义(P均>0.05)。结论肾移植术后早期撤除激素的免疫抑制方案不增加肾移植受者术后AR的发生率,使用该方案的肾移植受者血糖、血脂均优于常规使用激素免疫抑制方案,且采用2种免疫抑制治疗方案的肾移植受者及移植肾存活率相近。

Objective To evaluate the clinical efficacy and safety of early steroid withdrawal therapy after kidney transplantation.Methods Fiftyfive patients with early steroid withdrawal therapy over 1 year after kidney transplantation were selected were assigned into the early withdrawal group,and 60 patients receiving steroid immunosuppressive therapy were allocated into the control group.The changes in the blood glucose and lipid levels and the incidence of postoperative infection and acute rejection(AR)were recorded within 1 year after kidney transplantation between two groups.The renal function parameters at postoperative 1 year were statistically compared between two groups.During postoperative followup,the survival of the recipients and transplanted kidney was observed in two groups.Results At postoperative 1 year,the blood glucose and lipid levels and the incidence of lung infection in the early withdrawal group were significantly lower(allP<0.05),whereas the urinary protein level was considerably higher(P<0.001)compared with those in the control group.The levels of serum creatinine and blood urea nitrogen did not significantly differ between two groups(bothP>0.05).The incidence of AR,cardiovascular diseases,urinary system infection,digestive system infection and nervous system infection did not significantly differ between two groups(allP>0.05).No statistical significance was noted in the survival curves of recipients and transplanted kidneys between two groups(bothP>0.05).Conclusions Early steroid withdrawal therapy after renal transplantation does not increase the incidence of AR in the recipients.The blood glucose and lipid levels in the recipients receiving this regimen are better than those in their counterparts treated with conventional hormone immunosuppressive therapy.Besides,the survival rates of the recipients and transplanted kidneys are equivalent between two regimes.