摘要
目的 :探讨调整免疫抑制药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 32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药 (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霉酚酸酯 (MMF)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霉酚酸酯用量的 2 6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 2 1例 (6 5 .6 % )患者移植肾功能得以好转或不再继续恶化 ,而B组除 3例 (11.5 % )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药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。这种药物调整是安全的。
Objective: To investigate whether reduced or discontinued calcineurin inhibitor (CNI) has a role in improving renal function among renal transplant recipients with chronic allograft nephropathy (CAN).Method: 58 renal transplant recipients with declining graft function and biopsy proven CAN were studied.Within 1～2 weeks,32 recipients (group A) had CNI (cyclosporine or tacrolimus ) discontinued or reduced to one third of their original doses with increasing Azathioprine (Aza) or mycophenolate mofetil (MMF) properly. The doses of CNI in another 26 recipients (group B) were not obviously changed with only increasing Aza or MMF properly.All patients were followed up at least one year. Renal functions were compared between the two groups.The incidence of acute renal graft rejection were calculated in both groups.Result: One year later,there were 21 patients (65.6%) with stabilized or improved graft function in group A, and 3 patients (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 could stabilize or improve their renal functions. The adjusted dose of immunosuppressive agents had not increased the risk of acute rejection.
出处
《中国药师》
CAS
2003年第9期568-570,共3页
China Pharmacist
关键词
肾移植
肾病
免疫抑制药
Kidney transplantation
Nephropathy
Immunosuppressive agent
