肾移植术后环孢素A肝毒性防治回顾性分析

目的 分析肾移植术后环孢素A（CsA）及普乐可复（FK506）等免疫抑制剂的肝毒性以及防治措施。方法分析346例肾移植患者术后90天内静脉血谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（BILJ）、直接胆红素（BILD）含量，判定患者肝功能状况；以及相应的治疗措施及其效果，综合判定治疗措施的合理性。结果 CsA组肝功能异常发生率为26．90％，术后两周ALT、AST和BILD明显升高（P〈0．01），BILT升高（P〈0．05）；FK506组肝功能异常发生率为7．14％，ALT、AST、BILT和BILD略升高（P〉0．05）；骁悉（肿）和布累迪宁（MRZ）组肝功能异常发生率无明显区别。18例转换FK506 1周后，ALT、AST、BILT和BILD均明显降低（P〈0．01）。结论 CsA肝毒性为肾移植术后常见并发症，FK506肝毒性明显低于CsA；密切检测CsA浓度以及依据CsA浓度下限用药是预防肝毒性的关键；对于严重肝功能障碍患者，转换FK506是有效的治疗途径。

Analysis of prevention and treatment of cyclosporine-As hepatotoxicity in patients with renal transplantation

Objective To study the hepatotoxicity of cyclosporine-A, tacrolimus and other immunosuppressive drugs in patients with renal transplantation. Methods In 346 cases undergone renal transplantation, ALT, AST, BILT and BILD levels of venous blood 1-90 days after operation, and treatment methods and outcome were reviewed, in order to evaluate the effectiveness of the treatment of hepatotoxicity. Results In CsA group, the occurrence rate of liver dysfunction was 26.9%, in whom ALT, AST and BILD increased apparently (P<0.01). In FK506 group, the incidence of hepatic dysfunction was 7.14%, and ALT, AST and BILD increased but with no statistisally significant difference (P>0.05). In MMF and MRZ group, the incidence of liver dysfunction was almost the same. In 18 cases the drug was changed into FK506, ALT, AST, BILT and BILD all apparently decreased 1 week later (P<0.01). Conclusion The hepatotoxicity of cyclosporine-A is the common complication of renal transplantation, that of tacrolimus is apparently lower. The key of preventing hepatotoxicity is to pay more attention to monitor cyclosporine-A concentration in blood, and adjust the dosage of the drug to achieve a low efficacions limit of cyclosporine-A concentration. For the patients with serious liver dysfunction, it is advisable to change cyclosporine-A to tacrolimus.