目的:观察肾移植术后不同时间麦考酚酸暴露量的变化,为肾移植术后麦考酚吗乙酯剂量的调整提供理论依据。方法:16例首次肾移植患者,均于肾移植术后24小时内给予麦考酚吗乙酯(mycophenolate mofetil,MMF)1.5g/d治疗,长期应用。于术后第7...目的:观察肾移植术后不同时间麦考酚酸暴露量的变化,为肾移植术后麦考酚吗乙酯剂量的调整提供理论依据。方法:16例首次肾移植患者,均于肾移植术后24小时内给予麦考酚吗乙酯(mycophenolate mofetil,MMF)1.5g/d治疗,长期应用。于术后第7日、第28日、第90日测定其服药前、服药后半小时及服药后2小时的麦考酚酸的血药浓度,采用Shaw简易公式计算对应的麦考酚酸血药浓度-时间曲线下面积(the area under the drug concentration in the plasma versurs time curve,AUC)并比较其差异。结果:术后第7日、第28日、第90日的麦考酚酸AUC分别为(32±9)(mg/L).h、(41±10)(mg/L).h和(47±13)(mg/L).h,比较差异均有统计学意义(均为P<0.05)。结论:在术后3个月内连续服用同等剂量(1.5g/d)MMF的情况下,麦考酚酸AUC逐渐升高,在术后第90日达到(47±13)(mg/L).h,已超过能有效预防急性排斥反应的AUC。提示应在用药的90日内监测麦考酚酸AUC,并及时减少用量,以免发生严重的不良反应。展开更多
目的:探讨肾移植患者手术后应用麦考酚酸吗乙酯[简称霉酚酸酯(mycophenolate mofetil,MMF)]对人类白细胞抗原(human leucocyte antigen,HLA)抗体和抗供者特异性抗体(donor specific antibody,DSA)产生的影响。方法:252例患者分成3组,A组...目的:探讨肾移植患者手术后应用麦考酚酸吗乙酯[简称霉酚酸酯(mycophenolate mofetil,MMF)]对人类白细胞抗原(human leucocyte antigen,HLA)抗体和抗供者特异性抗体(donor specific antibody,DSA)产生的影响。方法:252例患者分成3组,A组(130例)免疫抑制剂为MMF+环孢菌素A(cyclosporin A,CsA)/他克莫司(FK506)+泼尼松(Pred);B组(49例)起始免疫抑制方案中未含MMF,术后6个月与MMF联用;C组(73例)应用含硫唑嘌呤(azathioprine,Aza)免疫抑制方案,CsA/FK506+Aza+Pred。采用酶联免疫吸附法检测患者群体反应性抗体,以鉴别抗HLA-Ⅰ型或Ⅱ型。结果:A,B,C组分别检测出17.7%,26.5%和31.5%抗HLA抗体;DSA检测率分别为8.5%,17.2%和20.0%,非抗供者特异性抗体(non-donor specific antibody,NDSA)检测出10.0%,21.4%和25.7%。DSA阳性者术后平均血肌酐水平及排斥反应发生率均高。多数接受再次移植者体内均可检测到DSA。结论:MMF可明显降低肾移植受者抗HLA-Ⅰ,Ⅱ抗体的产生,降低DSA产生。术后立即给予MMF较术后6个月再服效果更佳;术后受者血清中若检测出DSA,预示移植肾预后不佳。HLA抗体与移植物失功、排斥反应有明显相关性;而体内仅存NDSA,则移植效果相对好。MMF可明显降低移植物排斥反应,提高肾移植术后患者生存质量。展开更多
AIM: To develop an experimental model of islet allotransplantation in diabetic rats and to determine the positive or adverse effects of MMF as a single agent. METHODS: Thirty-six male Wistar rats and 18 male Lewis rat...AIM: To develop an experimental model of islet allotransplantation in diabetic rats and to determine the positive or adverse effects of MMF as a single agent. METHODS: Thirty-six male Wistar rats and 18 male Lewis rats were used as recipients and donors respectively. Diabetes was induced by the use of streptozotocin (60 mg/kg) intraperitoneally. Unpurified islets were isolated using the collagenase digestion technique and transplanted into the splenic parenchyma. The recipients were randomly assigned to one of the following three groups: group A (control group) had no immunosuppression; group B received cyclosporine (CsA) (5 mg/kg); group C receivedmycophenolate mofetil (MMF) (20 mg/kg). The animalswere killed on the 12th d. Blood and grafted tissues were obtained for laboratory and histological assessment. RESULTS: Median allograft survival was significantly higher in the two therapy groups than that in the controls (10 and 12 d for CsA and MMF respectively vs 0 d for the control group, P＜0.01). No difference in allograft survival between the CsA and MMF groups was found. However,MMF had less renal and hepatic toxicity and allowed weight gain.CONCLUSION: Monotherapy with MMF for immunosu ppression was safe in an experimental model of islet allotransplantation and was equally effective with cyclosporine, with less toxicity.展开更多
据健康日新闻（Health Day，11／11，Norton）报道。一项于11月10日发表在内科年鉴（Annals of Internal Medicine）上的研究表明，联合用药或许能为对抗狼疮性肾炎提供更好的治疗方法。该研究进行了一个由300名中国患者参与的临床试验...据健康日新闻（Health Day，11／11，Norton）报道。一项于11月10日发表在内科年鉴（Annals of Internal Medicine）上的研究表明，联合用药或许能为对抗狼疮性肾炎提供更好的治疗方法。该研究进行了一个由300名中国患者参与的临床试验，试验结果显示同时给予免疫调节剂麦考酚酸吗乙酯、抗生素他克莫司和一种类同醇类药物，对狼疮性肾炎患者症状完全缓解的可能性更大。展开更多
文摘目的:观察肾移植术后不同时间麦考酚酸暴露量的变化,为肾移植术后麦考酚吗乙酯剂量的调整提供理论依据。方法:16例首次肾移植患者,均于肾移植术后24小时内给予麦考酚吗乙酯(mycophenolate mofetil,MMF)1.5g/d治疗,长期应用。于术后第7日、第28日、第90日测定其服药前、服药后半小时及服药后2小时的麦考酚酸的血药浓度,采用Shaw简易公式计算对应的麦考酚酸血药浓度-时间曲线下面积(the area under the drug concentration in the plasma versurs time curve,AUC)并比较其差异。结果:术后第7日、第28日、第90日的麦考酚酸AUC分别为(32±9)(mg/L).h、(41±10)(mg/L).h和(47±13)(mg/L).h,比较差异均有统计学意义(均为P<0.05)。结论:在术后3个月内连续服用同等剂量(1.5g/d)MMF的情况下,麦考酚酸AUC逐渐升高,在术后第90日达到(47±13)(mg/L).h,已超过能有效预防急性排斥反应的AUC。提示应在用药的90日内监测麦考酚酸AUC,并及时减少用量,以免发生严重的不良反应。
文摘目的:探讨肾移植患者手术后应用麦考酚酸吗乙酯[简称霉酚酸酯(mycophenolate mofetil,MMF)]对人类白细胞抗原(human leucocyte antigen,HLA)抗体和抗供者特异性抗体(donor specific antibody,DSA)产生的影响。方法:252例患者分成3组,A组(130例)免疫抑制剂为MMF+环孢菌素A(cyclosporin A,CsA)/他克莫司(FK506)+泼尼松(Pred);B组(49例)起始免疫抑制方案中未含MMF,术后6个月与MMF联用;C组(73例)应用含硫唑嘌呤(azathioprine,Aza)免疫抑制方案,CsA/FK506+Aza+Pred。采用酶联免疫吸附法检测患者群体反应性抗体,以鉴别抗HLA-Ⅰ型或Ⅱ型。结果:A,B,C组分别检测出17.7%,26.5%和31.5%抗HLA抗体;DSA检测率分别为8.5%,17.2%和20.0%,非抗供者特异性抗体(non-donor specific antibody,NDSA)检测出10.0%,21.4%和25.7%。DSA阳性者术后平均血肌酐水平及排斥反应发生率均高。多数接受再次移植者体内均可检测到DSA。结论:MMF可明显降低肾移植受者抗HLA-Ⅰ,Ⅱ抗体的产生,降低DSA产生。术后立即给予MMF较术后6个月再服效果更佳;术后受者血清中若检测出DSA,预示移植肾预后不佳。HLA抗体与移植物失功、排斥反应有明显相关性;而体内仅存NDSA,则移植效果相对好。MMF可明显降低移植物排斥反应,提高肾移植术后患者生存质量。
基金Supported by the Special Research Fund, Account Code: 4280, National and Kapodistrian University of Athens, Greece
文摘AIM: To develop an experimental model of islet allotransplantation in diabetic rats and to determine the positive or adverse effects of MMF as a single agent. METHODS: Thirty-six male Wistar rats and 18 male Lewis rats were used as recipients and donors respectively. Diabetes was induced by the use of streptozotocin (60 mg/kg) intraperitoneally. Unpurified islets were isolated using the collagenase digestion technique and transplanted into the splenic parenchyma. The recipients were randomly assigned to one of the following three groups: group A (control group) had no immunosuppression; group B received cyclosporine (CsA) (5 mg/kg); group C receivedmycophenolate mofetil (MMF) (20 mg/kg). The animalswere killed on the 12th d. Blood and grafted tissues were obtained for laboratory and histological assessment. RESULTS: Median allograft survival was significantly higher in the two therapy groups than that in the controls (10 and 12 d for CsA and MMF respectively vs 0 d for the control group, P＜0.01). No difference in allograft survival between the CsA and MMF groups was found. However,MMF had less renal and hepatic toxicity and allowed weight gain.CONCLUSION: Monotherapy with MMF for immunosu ppression was safe in an experimental model of islet allotransplantation and was equally effective with cyclosporine, with less toxicity.
文摘据健康日新闻（Health Day，11／11，Norton）报道。一项于11月10日发表在内科年鉴（Annals of Internal Medicine）上的研究表明，联合用药或许能为对抗狼疮性肾炎提供更好的治疗方法。该研究进行了一个由300名中国患者参与的临床试验，试验结果显示同时给予免疫调节剂麦考酚酸吗乙酯、抗生素他克莫司和一种类同醇类药物，对狼疮性肾炎患者症状完全缓解的可能性更大。
