他克莫司和环孢素A对肾移植后患者炎性细胞因子和血脂的影响

背景：环孢素A与他克莫司是肾移植后临床广泛应用的免疫抑制剂。目的：观察他克莫司和环孢素A对肾移植后炎性细胞因子和血脂的影响。方法：选择首次接受同种异体肾移植后患者112例,随机分为环孢素A组和他克莫司组,移植后分别给予环孢素A+吗替麦考酚酯+糖皮质激素三联疗法与他克莫司+吗替麦考酚酯+糖皮质激素三联疗法。结果与结论：他克莫司组的1年人/肾存活率、治疗逆转率高于环孢素A组(P < 0.05),急性排斥反应发生率低于环孢素A组(P < 0.05);移植后1个月及1年的血清白细胞介素2,6,8和血糖水平高于移植前(P < 0.05),低于环孢素A组(P < 0.05),血清白细胞介素4,10低于移植前(P < 0.05),高于环孢素A组(P< 0.05);移植后1个月的血清总胆固醇、三酰甘油和低密度脂蛋白胆固醇高于移植前(P < 0.05),但低于环孢素A组(P < 0.05);移植后1年的血清总胆固醇和低密度脂蛋白胆固醇低于环孢素A组(P < 0.05)。说明他克莫司可通过抑制肾移植后炎性细胞因子释放,改善糖脂代谢等途径降低患者的排斥反应,提高肾移植的存活率。

Effects of tacrolimus and cyclosporine A on inflammatory cytokines and blood lipid after renal transplantation

BACKGROUND:Tacrolimus (FK506) and cyclosporine A (CsA) are widely used immunosuppressive agents after renal transplantation in the clinic.OBJECTIVE:To investigate the effects of FK506 and CsA on inflammatory cytokines and blood lipid after renal transplantation. METHODS:Totally 112 patients who received renal allograft for the first time were randomly divided into two groups. The CsA group received a triple therapy of CsA, mycophenolate mofetil and glucocorticoid. The FK506 group received a triple therapy of FK506, mycophenolate mofetil and glucocorticoid. 1-year survival rate, reversing rate, serum concentrations of interleukin (IL)-2, IL-4, IL-6, IL-8, IL-10, fasting plasma glucose and blood lipid were measured in the FK50 and CsA groups. RESULTS AND CONCLUSION:In the FK506 group, 1-year survival rate and reversing rate were significantly higher, while acute rejection rate was significantly lower, compared with the CsA group (P < 0.05). In the FK506 group, serum concentrations of IL-2, IL-6, IL-8 and fasting plasma glucose at 1 month and 1 year after transplantation were significantly higher compared with before transplantation (P < 0.05) and CsA group (P < 0.05). In the FK506 group, serum concentrations of IL-4 and IL-10 at 1 month and 1 year after transplantation were significantly lower compared with before transplantation (P < 0.05), but significantly higher compared with the CsA group (P < 0.05). In the FK506 group, total cholesterol, triacylglycerol and low density lipoprotein cholesterol at 1 month after transplantation were significantly higher compared with before transplantation (P < 0.05), but were significantly lower compared with the CsA group (P < 0.05). In the FK506 group, total cholesterol and low density lipoprotein cholesterol at 1 year after transplantation were significantly lower compared with CsA group (P < 0.05). These findings suggest that FK506 may reduce acute rejection and increase survival rate of renal transplantation via inhibiting the release of cytokines and improving glucose and lipid metabolisms.