低剂量他克莫司对肾移植受者氧化应激和Th1/Th2细胞因子水平的影响

The effects of low-dose tacrolimus in kidney allograft recipients on serum oxidative stressand Th1/Th2 cytokine levels

目的 :通过测定血清氧化应激指标和血清Th1/Th2细胞因子水平的方法,评估低剂量他克莫司方案对肾移植受者的有效性和安全性。方法 :回顾规律随访的肾移植受者共83例,其中43例维持期他克莫司浓度低于5ng/mL,为低剂量组,40例维持期他克莫司浓度高于5ng/mL者为标准剂量对照组。所有患者均服用他克莫司、吗替麦考酚酯、泼尼松三联免疫抑制方案。比较两组患者肾移植1年后的肾功能情况以及1年内不良事件的发生率,测定术后3月,6月和1年时血清氧化应激指标和血清Th1/Th2细胞因子水平。结果 :两组受者于肾移植术后1年时的肾功能无显著差异,1年内死亡、移植肾失功、急性排斥反应、感染、心血管疾病的发生率无显著差异,而低剂量组(4.7%)移植后糖尿病的发病率显著低于标准剂量组。术后3个时期两组间的超氧化物歧化酶(SOD)、丙二醛(MDA)和晚期氧化蛋白产物(AOPP)水平均无显著差异;两组SOD水平随时间延长有升高趋势,MDA水平有降低趋势,而AOPP水平无显著差异。术后3个时期两组间的IL-2、IL-4和IL-2/IL-4水平均无显著差异;两组IL-2水平随时间延长有降低趋势,IL-4水平有升高趋势,IL-2/IL-4水平有升高趋势。结论 :低剂量他克莫司方案相对于标准剂量方案可以降低肾移植受者移植后糖尿病的发生率,并不增加不良事件的发生,且不会影响对血清氧化应激指标和Th1/Th2细胞因子的变化。

Objective To assess the safety and effectiveness of low-dose tacrolilmus in kidney allograft recipientsby measuring serum oxidative stressand Th1/Th2 cytokine levels. Methods Data of 83 kidney allograft recipients was reviewed, in which 43 patientswhose maintenance period tacrolimus concentration was lower than 5 ng/ml were classified as low-dose group, and 40 patientswhosetacrolimus concentration is higher than 5 ng/ml were classified as standard dose group. All the patients were treated with tacrolimus, mycophenolatemofetil and prednisone. The renal function and adverse events were compared between two groups. The oxidative stress and serum Th1/Th2 cytokines level were measured in 3 months, 6 months and 1 year after transplantation. Results There was no significant difference in kidney function and incidence of adverse events except post transplantation diabetes millets between 2 groups in 1 year after transplantation. There was no significant difference in SOD, MDA and AOPP levels in 3 points between 2 groups. The serum level of SOD increased and MDA decreased over time. There was no significant difference in IL-2, IL-4 and IL2/IL4 levels in 3 points between 2 groups. The serum level of IL-2 decreased and IL-4 and IL-2/IL-4 increased as time prolonged. Conclusion Low-dose tacrolimusinkidney allograft recipients were safe and effective, which could reduce the incidence of post transplantation diabetes millets, and could not affect the oxidative stress and Th1/Th2 cytokine levels.