肝移植患者使用基于他克莫司或环孢素的免疫抑制方案后3年内肾功能的变化比较

Comparison of renal function in liver transplant patientstreated with tacrolimus-based or cyclosporin-based immunosuppressive regimens within 3 years

目的:在这项回顾性研究中,分析了肝移植术后患者连续使用钙调磷酸酶抑制剂(环孢素vs他克莫司)前3年内的肾功能变化。方法:回顾性分析某院肝脏移植中心214名肝移植(LT)患者的资料。所有患者在LT后的前3年内均接受以钙调磷酸酶抑制剂(CNI)为基础的免疫抑制治疗,收集患者随访期间(6,12,18,24,36个月)各项指标包括血常规、肝肾功能、血糖、免疫抑制剂药物剂量及浓度等,比较患者随访期间肾功能的变化情况。结果:2组患者在接受CNI为基础的免疫抑制方案治疗后的前3年内肾功能均有不同程度的下降,环孢素组患者在移植后半年内即出现肾功能的恶化(P<0.05),而他克莫司组患者肾功能1年后也出现了显著恶化(P<0.05)。结论:与接受基于TAC的免疫抑制方案治疗的患者相比,CSA组出现肾功能恶化更明显,尤其是在LT后的前6个月。

OBJECTIVE In this retrospective study,changes in renal function during the first 3 years of continuous use of a calcineurin inhibitor(cyclosporine(CSA)vs.Tacrolimus(TAC))after liver transplantation were analyzed.METHODS Data of 214 LT patients in the liver transplantation center of our hospital were retrospectively analyzed.All patients were treated with CNI-based immunosuppressive agents within the first 3 years after LT.During the follow-up period(6,12,18,24,36 months),indicators including blood routine,liver and kidney function,blood glucose,immunosuppressive drug concentration were collected to compare the changes of renal function during the follow-up period.RESULTS Renal function decreased to some extent in the first 3 years after CNI-based immunosuppressive regimen in both groups.Patients in cyclosporine group had deterioration of renal function within 6 months after transplantation(P<0.05),while patients in tacrolimus group also had significant deterioration of renal function after 1 year(P<0.05).CONCLUSION Renal function deterioration was more pronounced in the CSA group compared with patients treated with TAC-based immunosuppressive regimens,especially in the first 6 months after LT.