雷公藤多苷对移植肾长期存活率的影响

目的:探讨雷公藤多苷(TW)作为免疫抑制剂对肾移植患者长期存活率的疗效及副作用.方法:104例患者在肾移植术后采用TW 泼尼松(Pred) 环孢霉素(GsA) 硫唑嘌呤(AZa)免疫抑制剂治疗,48例患者在肾移植术后采用Pred GsA 骁悉(MMF)免疫抑制剂治疗,就以下方面对两组患者进行观察比较:(1)术后5年内发生排斥反应及临界改变情况;(2)外周血白细胞下降、肝功能异常的发生率;(3)严重感染情况;(4)出现尿蛋白情况;(5)术后5年内肾功能变化情况及移植肾5年存活率.结果:5年内AZa TW组急性排斥反应及临界改变的发生率较MMF组低,分别为11.5%、16.7%和4.8%、6.3%(P＞0.05);GPT高于正常的发生率分别为7.7%、16.6%(P＞0.05);外周血白细胞低于正常的发生率分别为0.96%、18.8%(P＜0.01);严重感染的发生率分别为1.9%、18.8%(P＜0.05),5年内出现蛋白尿的患者例数分别为17.3%、29.2%(P＞0.05),两组移植肾5年存活率相似,分别为89.6%、85.4%(P＞0.05).结论:在肾移植术后应用CsA Pred AZa TW免疫抑制方案是可行的,既可以使肾移植术后急性排斥反应减少,同时还能减少蛋白尿及慢性排斥反应的发生率下降,为国内提高移植肾长期存活率提供了一条新的途径.

The Effect of Multiglycosides of Tripterygium Wilfordii in Allograft Kidney Transplantation

Objective:To investigate the long-term immunosuppressive and side effect of multiglycosides of Tripterygium Wilfordii (TW)in allograft kidney transplantation.Methods:104 allograft kidney transplantation recipients received TW Pred CsA Aza therapy while the other 48 received Pred CsA MMF. After 5-year observation the two groups were compared by the following:(1)biopsy-proved acute rejection or borderline change;(2)abnormal change of transaminase and white blood cells counts;(3)serious infection;(4)proteinuria;(5)prognosis and the change of Cre.Results:The incidence of acute rejection and that of biopsy-proved borderline change of the MMF group are higher than the TW group (16.7% vs 11.5% and 6.3%vs4.8%)(P>0.05).There were more recipients presenting proteinuria (29.2%vs 17.3%) and GPT above normal in the MMF group (16.6%vs7.7%) but the difference has no reaeched statistic significance. While incidence of serious infection (18.8%vs1.9%) and WBC counts under normal level (18.8%vs0.96%) are significantly high in the MMF group.The five-year prognosis of TW group and MMF group is resemble (89.6%:85.4%)(P>0.05).Conclusion:It was effective to perform CsA Pred AZa TW protocol after renal transplantation,for having decreased acute rejection ration and proteinuria level.We concluded that it was a new Pathway to improve the long-term allograft survival ratio after renal transplantation.