肾移植术后抗排斥药FK506的临床应用

目的研究FK506预防肾移植术后排斥反应的效果和安全性。方法肾移植患者22例，其中18例为始用组，4例为切换组。FK506起始用0.2me／(kg·d)，以后逐步减量，3个月后维持血浓度于3～12μg/L水平。切换组于停用CsA24h后应用FK506，剂量和血浓度与始用组相同。同时合并应用MMF0.5g，每日3次口服，以及术后前10天大剂量甲基强的松龙静滴，第11天改强的松口服并减量，6个月后维持强的松15mg／d。所有病例均严密观察并行血尿等生化分析。结果始用组移植肾功能好，平均血肌酐水平l02μmol／L，无一例出现排斥反应。切换组中2例异常的肝功能好转；肾功能进行性减退的2例切换后，血肌酐相对稳定。有血糖升高4例和高血压5例，用药后能控制，其他副反应有上呼吸道和下尿路感染、胸痛、恶心、呕吐、腹泻、腹部不适等。结论FK506是肾移植术后有确切疗效的基础抗排斥药，与MMF、皮质醇合用能有效地预防急性排斥的发生，并可控制慢性排斥的进展。应用剂量适当，无明显的肝、肾毒副作用，但有血糖升高及高血压副作用，药物可以控制。其它呼吸道、尿路、消化道和神经系统副反应轻，不妨碍临床用药。

CLINICAL USE OF FK506 AS PRIMARY ANTI-REJECTION AGENT IN RENAL ALLOGRAFT RECIPEINTS

OBJECTIVE To report our primary experience with the efficacy and safety of FK506 in the prevention of renal allograft re-jection. METHODOLOGY Between Oct 1998 and Feb 2000,22 cases of renal recipients (male/female 17/5)administeredFK506 as the primary anti-rejection agent in their anti-rejection regime(FK506, MMF, steroid). For the 18 patients who startedFK506 treatment after transplantation,the initial dosage of FK506 was 0.2 mg/(kg·d) with the trough serum concentration about6-15 μg/L, and the dosage was tailed off within the first 6 months, and trough serum level of FK506 maintained at 3-12 μg/L there-after. For the 4 patients switched from cyclosporin A treatment to FK506 treatment,FK506 was started at 0.2mg/(kg·d) and ad-justed to maintained the trough serrum level in the rang of 3-12 μg/L. RESULTS In patients started FK506 treatment after op-eration, there was no loss of graft or patients, nor rejection episodes observed. In 2 patients switched from CsA for hepatoxicity, hep-atic function recovered to normal, and in another 2 patients switched fiom CsA for chronic renal graft rejection, serum creatinine re-mained stable. Hyperglycemia was observed in 4( 18.2% ), hypertension in 5(22.7% ), respiratory infection in 2(9.1% ), urinarytract infection in 3( 13.6% ). CONCLUSION FK506 used as a primary anti-rejection agent is effective and safe in renal graftrecipients. Combination of FK506 and MMF plus steroids is the best regime for the prevention of both acute and chronic rejection.