他克莫司对肾移植后糖代谢的影响及其控制

目的：制定他克莫司（PK506）治疗窗浓度，并控制肾移植后糖尿病（PTDM）的发生和发展。方法：对肾移植术后用PK506为基础的免疫抑制剂治疗的20例受者，进行回顾性研究，结果：20例患者随访1年，4例发展为糖尿病，发生率为20％，患者发病前4－8周都经受较高FK506浓度（20－28μg/L）作用，经降低泼尼松（Pred)用量、结合胰岛素替代治疗效果不佳，后经调整FK506浓度为：第1个月5－15μg/L，第2个月起5－10μg/L。2例血糖完全恢复正常，另2例因急性并发症转换为环孢素A（CsA)治疗。治疗期间无1例出现急性排斥和血肌酐升高。结论FK506具有强效免疫抑制作用，可防止急性排斥发生，在使用FK506期间，一旦发生PTDM，可通过减少Pred用量降低FK506浓度，同时使用胰岛素控制其发生、发展。如出现急性并发症，可将FK506转换为CsA。

The effect of tacrolimus on carbohydrate metabolism and controlling

Objective　To make a proper therapy window concentration of tacrolimus and to control the development of post-transplantation diabetic mellitus (PTDM). Method　The data of 20 renal allograft patients with tacrolimus-based regimen were retrospectively analyzed.Results　After follow-up for one year, 4 cases developed into PTDM with the incidence being 20%. All patients had been under the high concentration of tacrolimus (20～28μg/L) for 4～8 weeks before symptoms appeared. It was insufficient to control the blood sugar level by reducing prednisone dosage or adding insulin simply. By regulating the tacrolimus concentration, 2 cases recovered completely and 2 cases converted to cyclosporine-based therapy because of acute complications. During follow-up, no acute rejection episode occurred. Conclusions　High level of tacrolimus can produce toxicity on islet cell. Once PTDM happened, it may be important to decrease prednisone dosage, combine insulin and down-regulate the concentration of tacrolimus. CsA could be used again in the presence of acute complications.