肾移植术后早期应用雷帕霉素的疗效和并发症观察

目的:评价肾移植术后早期应用雷帕霉素(RPM)的疗效和安全性。方法:58例同种尸体供肾移植患者分为试验组(28例)与对照组(30例),免疫抑制方案分别为环孢素A(CsA)+RPM+强的松(Pred)、CsA+霉酚酸酯(MMF)+Pred。观察2组在移植术后6月内的疗效、并发症及药品不良反应情况,同时监测血脂水平、肝肾功能等生化指标,分析2种免疫抑制方案对移植肾急性排斥反应、人/肾存活率的影响。结果:2组患者观察期内均移植肾带功存活。试验组急性排斥反应发生率(4/28,14.3%)稍低于对照组(5/30,16.7%),差异无统计学意义。试验组发生血脂异常11例(39.3%),切口感染4例(14.3%),腹泻3例(10.7%),白细胞减少1例(3.6%);对照组中血脂异常3例(10.0%),切口感染2例(6.7%),腹泻8例(26.7%),白细胞减少5例(16.7%)。结论:肾移植术后早期应用CsA+RPM+Pred三联免疫抑制治疗方案,会产生更强的免疫抑制效果,术后急性排斥反应发生率稍低于对照组。其主要副作用是血脂升高和切口感染,但腹泻和白细胞减少的发生率明显低于对照组。

Efficacy of Early Use of Rapamycin for Patients after Renal Transplantation and the Complications

OBJECTIVE： To evaluate the efficacy and safety of early use of rapamycin in renal transplant recipients. METHODS： A total of 58 patients undergoing renal transplantation （with kidneys came from corpses） were assigned to receive cyclosporine A （CsA） plus rapamycin （RPM） and prednisone （trial group, n = 28） or CsA plus mycophenolate （MMF） and prednisone （control group, n = 30） . The clinical efficacy at 6 months after renal transplantation, the complications and the adverse drug reactions of the two groups were observed, meanwhile, biochemical indicators including serum blood lipid level and hepatic and renal functions were monitored to analyze the effects of two immunosuppressive schemes on acute rejection of the transplanted kidneys and the survival rates of patients/kidneys. RESULTS： The transplanted kidneys in both group all survived with function. There was no significant difference between the two groups in the incidence of acute rejection （4/28 （14.3%） for trial group vs. 5/30 （16.7%） for control group）. The abnormal serum lipid level, infection of incisional wound,diarrhea and hypoleukemia were noted in 11 cases （39.3%）, 4 cases （14.3%）, 3 cases （10.7%） and 1 case （3.6%） for the trial group vs. 3 cases （10.0%）, 2 cases （6.7%）, 8 cases （26.7%） and 5 cases （16.7%） for the control group. CONCLUSION： The early use of triple immunosuppressive therapy（CsA ＋ RPM ＋ Pred） showed more potent immunosuppressive efficacy but fewer acute rejections as compared the control group （CsA ＋ MMF ＋ Pred）. The main side effects of the trial group （CsA ＋ RPM ＋ Pred） manifested as increased serum lipid level and infection of incisional wound, however, the incidences of diarrhea and hypoleukemia were significantly lower than in the control group.