摘要
目的 明确调整免疫抑制剂的使用方案能否改善肾移植后慢性移植物肾病患者的肾功能。方法 对 2 5例 (A组 )慢性移植物肾病早期肾功不全的患者在 1～ 2周内将其神经钙蛋白阻滞剂 (环孢素A或他克莫司 )减少至原剂量的 1 3或完全停用 ,同时适当增加硫唑嘌呤或骁悉的用量 ,与同期内环孢素A或他克莫司未作大幅度减量、仅适当增加硫唑嘌呤或骁悉用量的 19例 (B组 )慢性移植物肾病患者进行对比 ,随访比较两组的移植肾功能 ,观察急性排斥反应情况。结果 1年后A组有 16例 (64 0 % )患者移植肾功能得以好转或不再继续恶化 ,而B组除 2例 (10 5 % )移植肾功能维持在原有水平外 ,其他患者肾功能均进行性恶化。两组急性排斥反应发生率无显著差异。结论 大幅度减少甚至停用神经钙蛋白阻滞剂可使部分肾移植后慢性移植物肾病患者的肾功能得以改善或者防止其进行性恶化。
Objective To investigate whether reduced or discontinued calcineurin inhibitor (CNI) can improve the renal functions of renal transplant recipients with chronic allograft nephropathy (CAN). Methods A total of 46 renal transplant recipients with declining graft function and biopsy proven CAN were studied. Within 1～2 weeks, CNI (Cyclosporine A or Tacrolimus ) in 27 recipients (group A) was discontinued or reduced to one third of their original doses, but Azathioprine (Aza) or mycophenolate mofetil (MMF) was increased properly. The doses of CNI in the 19 recipients (group B) were not changed obviously, but Aza or MMF was increased properly. At least 1-year follow-up was performed in all patients. Renal functions were compared between the two groups. The incidence of acute renal graft rejection was calculated in both groups. Results One year later, there were 17 patients (63.0%) with stabilized or improved graft function in group A, and 2 (10.5%) in group B. The difference was significant. The incidences of acute rejection in both groups were not significantly different. Conclusion For some renal transplant recipients with declining graft function and biopsy proven CAN, remarkably reduced or discontinued CNI can stabilize or improve their renal functions. Adjusting the doses of immunosuppressive agents does not increase the risk of acute rejection.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2002年第12期1460-1461,共2页
Journal of Third Military Medical University
关键词
肾移植
肾病
免疫抑制剂
kidney transplantation
nephropathy
immunosuppression
