肾移植受者应用西罗莫司的临床疗效

目的评价肾移植术后应用西罗莫司(SRL)的疗效和安全性。方法60例同种尸体供肾移植患者分为两组。①实验组(n=20):免疫抑制方案为环孢菌素A(CsA) SRL 强的松(Pred);②对照组(n=40):免疫抑制方案为CsA 霉酚酸酯(MMF) Pred。随访二组在术后6月内的疗效、并发症及药物不良反应情况,同时监测血脂水平、肝肾功能等生化指标;采用Kap lan-M e ier法分析两种免疫抑制方案对移植肾无急性排斥存活率的影响。结果对照组中1例患者术后3月时因肺部感染死亡,两组其他患者6个月内均带功能存活。除血脂水平外,两组其他实验室指标未出现统计学差异;但两组患者急性排斥发生率、并发症及药物的不良反应明显不同。实验组发生急性排斥2例(10%);移植肾功能延迟恢复1例(5%);肺部感染5例(25.0%);血脂异常11例(55.0%)。对照组中急性排斥8例(20%);移植肾功能延迟1例(2.5%);肺部感染6例(15.0%);血脂异常13例(32.5%);肝功能异常2例(5.0%);腹泻12例(30%),白细胞减少1例。结论肾移植术后应用CsA SRL Pred三联免疫抑制治疗方案,会产生更强的免疫抑制效果,其主要副作用是血脂升高。

Clinical Efficacy of Sirolimus in Renal Allograft Recipients

Objective To evaluate the efficacy and safety of sirolimus(SRL) after renal transplantation. MethodsSixty patients were divided into two groups:experimental group(n=20),cyclosporin A(CsA) SRL prednisone(Pred) triple immunosuppressive regimen;control group(n=40),CsA mycophnolate mofetil(MMF) Pred triple immunosuppressive regimen.Follow-ups were conducted in 6 months after transplantation and the therapeutic efficacy and safety were compared between the two groups.Actuarial graft acute rejection-free survival rate were compared by Kaplan-Meier method. Results One case died from lung infection 3 months after transplantation in the control group,while no other patients died during the 6 months.There was no statistical difference between the two groups in the routine laboratory tests except for dyslipidemia,but there were significant differences in acute rejection,side effects and complications.There were 2 cases of acute rejection(10.0%),1 case of delayed graft function(DGF,5.0%),5 cases of lung infection(25.0%),and 11 cases of dyslipidemia(55%) in the experimental group.While there were 8 cases of acute rejection(20%),1 case of DGF(2.50%),6 cases of lung infection(15.0%),13 cases of dyslipidemia(32.5%),2 cases of abnormal liver function(5.0%),12 cases of diarrhea(30.0%),and 1 case of hypoleukemia(2.50%) in the control group. Conclusion CsA SRL Pred triple regimen can lead to more efficienct immunosuppressive effect and hyperlipidemia is the major side effect of SRL.