肾移植术后患者应用西罗莫司对他克莫司剂量的影响

目的观察肾移植术后联合应用西罗莫司(雷帕霉素)对他克莫司(FK506)剂量的影响。方法60例肾移植术后患者随机分为两组,研究组30例,免疫抑制方案采用西罗莫司+他克莫司+泼尼松;对照组30例,采用麦考酚吗乙酯(MMF)+他克莫司+泼尼松联合治疗。术后随访2年,比较两组的人、肾存活率,急性排斥反应率,他克莫司用量,肾功能变化和不良事件发生率。结果研究组、对照组全部如期完成观察,两组的人肾存活率均为100%,研究组、对照组急性排斥反应发生率分别为7%(2/30)、10%(3/30),经肾上腺皮质激素(激素)冲击治疗后逆转;研究组在维持他克莫司血药浓度与对照组相当情况下,其用量低于对照组,比较差异有统计学意义(P0.05)。两组的不良事件发生率相近(60%比70%,P0.05)。结论联合西罗莫司+他克莫司+泼尼松方案用作肾移植术后免疫抑制治疗是安全有效的,且能减少他克莫司的剂量。

The influence on tacrolimus' dose in kidney transplantation recipients taking sirolimus

Objective To observe the influence on tacrolimus （FK506）＇ dose in kidney transplantation recipients taking rapamyein. Methods Sixty patients with de novo cadaveric kidney allograft were randomized into two groups. In study group, thirty patients were treated with sirolimus, FK506 and prednisone. In control group, thirty patients were treated with mycophenolate mofetil （ MMF）, FK506 and prednisone. The 2-year survival rate of patients/graft kidney, incidence rates of acute rejection, dose of FK506, change of kidney graft function and incidence rate of adverse event were compared in the two groups after renal transplantation. Results The observation of study group and control group had completed on time. The 2-year patient and graft survival rates in two groups were 100%. The incidence of acute rejection was 7% （2/30） in study group, 10% （3/30） in control group. But all rejections were reversed by prednisolone. The dose of FK506 was lower in study group than it in control group with the same concentration. The incidence rate of adverse event in the two groups was similar. Conclusion Sirolimus with FK506 is an effective and safe immunosupressive regimen for kidney transplantation and allows reducing the dose of FK506.