摘要
目的探讨来氟米特（LEF）替代霉酚酸酯（MMF）或硫唑嘌呤（Aza）进行免疫抑制治疗的可行性。方法选取肾移植后使用环孢素A（CsA）或他克莫司（FK506）＋MMF或Aza＋泼尼松三联免疫抑制方案的受者16例，用LEF替代MMF或Aza维持治疗，替换时间为肾移植术后1～50个月，平均（8．8±12．3）个月。结果受者使用LEF替代治疗1～18个月，平均（8．7±7．2）个月，其中9例使用LEF超过6个月，7例超过12个月，3例已服用了18个月。受者。肾功能稳定，换药前血肌酐为（103±24）μmol／L，换药半年后血肌酐为（95±26）μmol／L，换药1年后血肌酐为（108±27）μmol／L。16例受者中有1例因经济困难于1个月后退出观察，继续服用Aza；1例受者于半年后因血肌酐从130μmol／L增加到143μmol／L，要求恢复使用MMF。换药后发生急性细胞性排斥反应1例，轻度脱发2例，皮疹1例；未见肝功能明显异常、严重感染、贫血加重和血白细胞明显降低。结论。肾移植后用LEF替代MMF或Aza的免疫抑制剂方案是安全可行的。
Objective To evaluate the efficacy and safety of immunosuppressive strategy ot leflunomide （LEF） combined with calcineurin inhibitor and prednisone in Chinese renal transplant recipients. Methods Prospective clinical study was performed in 16 stable renal transplant recipients treated with calcineurin inhibitor, prednisone and either mycophenolate mofetil （MMF） or azathioprine （Aza）, and MMF or Aza was replaced by LEF afterward. The loading dose of LEF was 50 mg/day for 3-5 days, and the maintenance dose was 2μmg/day. Prednisone was maintained 10 mg/day. The doses of CsA were adjusted according to its blood concentration. Results One patient dropped due to economic reason 1 mouth later, and continued to take Aza. Another one patient switched back to MMF due to a slight increase of serum creatinine （from 130μmol/L to 143μmol/L） 6 months after conversion. The remaining 14 patients were still on LEF. The mean observation time under LEF was （8.7± 7.2） months （1-18 month）. The mean serum creatinine was （103± 24）μmol/L before conversion, （95±26）μmol/L at 6th month, and （108 ± 27）μmol/L at one year post conversion. There was one episode of biopsy proved reversible acute rejection. The observed side effect was tolerable alo pecia in 2 cases and rash in 1 case, but there were no significant increases in liver function, decrease of blood WBC count, deterioration of anemia, or any serious infection in any of the patients. Conclusion Immunosuppressive strategy of LEF ＋ calcineurin inhibitor and prednisone is effective and safe in stable Chinese renal transplant recipients.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2006年第4期218-220,共3页
Chinese Journal of Organ Transplantation
关键词
免疫抑制剂
肾移植
Immunosuppressive agents
Kidney transplantation
