他克莫司替换环孢素A联合雷公藤多甙片治疗慢性移植肾肾病

背景:近年来,多项研究表明环孢素A转换成他克莫司的免疫抑制方案对慢性移植肾肾病有一定疗效.目的:探讨他克莫司替换环孢素A联合雷公藤多甙片治疗慢性移植肾肾病的疗效及安全性.方法:回顾性分析经临床及病理证实为慢性移植肾肾病的患者57例,诊断前均采用环孢素A+吗替麦考酚酯+泼尼松免疫抑制治疗,然后根据不同的治疗方案分成两组:环孢素A组(n=27),继续采用原方案治疗;他克莫司+雷公藤多甙片组(n=30),环孢素A切换成他克莫司的同时再联用雷公藤多甙片治疗.结果与结论:转换后3,6个月两组间血肌酐、24 h尿蛋白水平比较差异均有显著性意义(P < 0.05),各组3个月与6个月的血肌酐、24 h尿蛋白水平比较差异均无显著性意义(P > 0.05),血总胆固醇、三酰甘油、丙氨酸氨基转换酶、天冬酸氨基转换酶等指标两组间差异无显著性意义(P > 0.05).他克莫司+雷公藤多甙片组震颤发生率较环孢素A组高(P < 0.05),但高血压、多毛症、血糖升高、牙龈增生的发生率显著低于环孢素A组(P < 0.05).结果表明他克莫司替换环孢素A联合雷公藤多甙片的治疗方案对慢性移植肾肾病有显著的疗效,且安全性能好,有助于移植肾的长期存活.

Conversion from cyclosporin A to tacrolimus combined with Tripterygium wilfordii Hook.f.for the treatment of chronic allograft nephropathy

BACKGROUND:In recent years,several studies have shown that immunosuppressive regimen of tacrolimus conversed from cyclosporine A(CsA) has a certain effect on chronic allograft nephropathy.OBJECTIVE:To investigate the clinical efficacy and safety of conversion from CsA to tacrolimus combined with Tripterygium wilfordii Hook.f.(TII) on CAN.METHODS:Retrospectively analysis of 57 patients with chronic allograft nephropathy diagnosed by clinical and pathological identification.The patients were treated with CsA+mycophenolate mofetil+prednisone immunosuppressive therapy before diagnosis,and then the patients were divided into two groups according to different treatment options:CsA group(n=27) which was continued to use the initial therapy,CsA+TII group(n=30) was treated by tacrolimus instead of CsA combined with TII.RESULTS AND CONCLUSION:There was significant difference on the level of serum creatinine and quantity of 24-hour urine protein excretion in two groups at 3 and 6 months after conversion(P < 0.05),but there were no statistical difference of those in each group at 3 and 6 months(P > 0.05).And there were no significant differences on the level of total cholesterol,triacylglycerol,alanine aminotransferase and aspartic acid aminotransferase between two groups(P > 0.05).The tremor incidence in CsA+TII group was obviously higher than that in the CsA group(P < 0.05),but the incidence of hypertension,hypertrichosis,hyperglycemia and gingival overgrowth in CsA+TII group was significantly lower than that in the CsA group(P < 0.05).Conversion from CsA to tacrolimus combined with TII has a good efficacy for the treatment of chronic allograft nephropathy in kidney transplant recipients with fewer adverse effects,which benefits for the long-term survival of allograft.