摘要
背景:对于稳定期肾移植受者,从环孢素向他克莫司转化的利弊尚不明确,一般认为环孢素的心血管风险更高,而他克莫司更易引起糖代谢的异常。目的:探讨将环孢素转换为他克莫司对稳定期肾移植受者糖代谢和心血管风险的影响。方法:将69例符合入组标准的肾移植受者随机分为转换组(n=36)和对照组(n=33),转换组将环孢素转换为他克莫司,对照组不转换。分别监测入组时、3个月和6个月时患者的血糖、血脂、血压、肾功能、心血管危险因素、体质量和联合用药情况等。该研究通过郑州市第七人民医院医学伦理委员会审核通过。结果与结论:从入组到转换6个月后,空腹血糖从(5.6±1.0) mmol/L增加到(6.0±1.2) mmol/L(P=0.007);糖化血红蛋白从(5.7±0.8)%增加到(6.0±1.2)%(P=0.016);在心血管危险因素中,纤维蛋白原从(3.16±0.7) g/L降到(2.89±0.7) g/L(P=0.015);高密度脂蛋白胆固醇水平从(1.76±0.5)mmol/L降到(1.65±0.4)mmol/L(P=0.012);体质量指数从(24.3±3.6)kg/m2降到(23.7±3.4)kg/m~2(P=0.037);其他指标无明显变化,包括肌酐、尿蛋白与肌酐比、血压、血脂(P> 0.05)。结果表明,将稳定期肾移植患者的免疫抑制剂方案从环孢素转换为他克莫司后血糖明显升高,而在降低心血管风险方面没有明显优势。
BACKGROUND:The pros and cons of conversion from cyclosporine to tacrolimus are unclear in stable kidney transplant patients.It is generally believed that cyclosporine increases cardiovascular risks,while tacrolimus has a negative effect on glucose metabolism.OBJECTIVE:To discuss the effects of conversion from cyclosporine to tacrolimus on glucose metabolism and cardiovascular risk in stable kidney transplant patients.METHODS:Sixty-nine renal transplant recipients who met the inclusion criteria were randomly divided into a conversion group(n=36,cyclosporine was converted to tacrolimus)and a control group(n=33,cyclosporine was given continuously).Blood glucose,blood lipid,blood pressure,renal function,cardiovascular risk factors,body mass and combination medication were monitored at enrollment,3 months and 6 months.The study was approved by the Ethics Committee of the 7 th People’s Hospital of Zhengzhou.RESULTS AND CONCLUSION:After 6 months of conversion,fasting blood glucose level increased from(5.6±1.0)to(6.0±1.2)mmol/L(P=0.007);the glycosylated hemoglobin level increased from(5.7±0.8)%to(6.0±1.2)%(P=0.016).Among cardiovascular risk factors,fibrinogen level decreased from(3.16±0.7)to(2.89±0.7)g/L(P=0.015);high-density lipoprotein cholesterol level decreased from(1.76±0.5)to(1.65±0.4)mmol/L(P=0.012);body mass index decreased from(24.3±3.6)to(23.7±3.4)kg/m~2(P=0.037).There were no significant changes in the other factors,including creatinine,urinary protein-creatinine ratio,blood pressure and blood lipid(P>0.05).These findings indicate that switching immunosuppressant therapy from cyclosporine to tacrolimus significantly increases blood glucose level in stable kidney transplant patients,with no evident advantage in reducing cardiovascular risk.
作者
王晓勃
王长安
韩健乐
杨青彦
杨帅平
杨俊伟
Wang Xiaobo;Wang Changan;Han Jianle;Yang Qingyan;Yang Shuaiping;Yang Junwei(Department of Kidney Transplantation and Nephrology,the 7th People’s Hospital of Zhengzhou,Zhengzhou 450016,Henan Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2021年第14期2236-2240,共5页
Chinese Journal of Tissue Engineering Research
关键词
肾移植
他克莫司
环孢素
免疫抑制
血糖
血脂
肾功能
心血管风险
kidney transplantation
tacrolimus
cyclosporine
immunosuppression
blood glucose
blood lipid
kidney function
cardiovascular risk
