摘要
目的 探讨乙型肝炎病毒携带者肾移植术后应用他克莫司（FK506）和环孢素A（CsA）对肝功能的影响。方法 73例乙型肝炎病毒（HBV）携带者接受肾移植，术前患者的肝功能正常，HBVDNA阴性。术后将患者分为两组：FK506组40例，术后服用FK506、霉酚酸酯（MMF）及泼尼松（Pred）预防排斥反应；CsA组33例，术后服用CsA、MMF及Pred预防排斥反应。术后追踪随访1～6年，观察两个组患者肝功能损害情况以及HBVDNA阳性率，发生肝功能损害时，调整免疫抑制剂的用量，并给予护肝治疗。结果 术后FK506组有4例（10．0％）、CsA组有16例（48．5％）发生肝功能损害，FK506组有2例（5．0％）、CsA组有9例（27．3％）HBVDNA转阳性，两组比较，差异均有统计学意义（P＜0.05）。CsA组肝功能损害的16例中，10例将CsA切换为FK506，另6例治疗方案不变，结果转换药物者肝功能恢复正常的时间明显短于未转换者（P〈0．01），且治疗1～2周时的丙氨酸转氨酶、天冬氨酸转氨酶和胆红素总量的水平也明显低于未转换者（P＜0．05，P＜0．01）。结论 与CsA相比，乙型肝炎病毒携带者肾移植术后应用FK506可降低肝功能损害的发生率，减少乙型肝炎复发。
Objective To observe the effect of tacrolimus vs cyclosporin A on liver function after kidney transplantation. Methods Seventy-three cases of HBV carriers received kidney transplantation. Their liver functions before operation were normal and HBV DNA was negative. After operation they were divided into two groups： FK506 group （n = 40） taking FK506, mycofenolate mofetil （MMF） and prednisone to prevent rejection. CsA group （n = 33） taking CsA, MMF and prednisone to prevent rejection. The cases were followed for 1 to 6 years. The incidence of liver function admage and HBV DNA positive rate were observed in two groups. When damage to liver function appeared, the doses of immunosuppresive drugs were regulated, and the drugs protecting liver function were given. Results Four cases （10. 0% ） in FK506 group and 16 cases （48. 5%） in CsA group suffered the damage to liver function. In 2 cases （5.0%） of FK506 group and 9 cases （27. 3%） of CsA group, HBV-DNA transferred to positive （P〈0. 05）. Among 16 cases of liver function injury in CsA group, 10 cases were converted to treatment of FK506, whose liver function injury recovered more rapidly than the remaining cases not changing regimen （P〈0. 01）. The ALT, AST and total bilirubin level of the former at first and second week after treatment were also significantly lower than those of the latter （P〈0. 05, P〈0. 01 ）. Conclusion Compared with CsA, FK506 can significantly lower the incidence of liver function injury after kidney transplantation for HBV carriers, and reduce Hepatitis B recurrent rate.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2006年第9期546-548,共3页
Chinese Journal of Organ Transplantation
关键词
肾移植
肝炎
乙型
他克莫司
环孢菌素
Kidney transplantation
Hepatitis B
Tacrolimus
Cyclosporine
