摘要
目的 :研究他克莫司 (Tacrolimus ,Prograf,FK5 0 6 )在肾移植术后抗排斥反应的效果及毒副作用。 方法 :2 94例肾移植受者术后服用FK5 0 6。其中 2 6 8例在术后 2 4h即开始服用FK5 0 6 ,起始量 0 15mg/ (kg·d) ;2 6例应用环孢素A(CsA)的患者在术后 7～ 14天内出现排斥反应 ,经甲基强的松龙 (MP)冲击治疗无效后改用FK5 0 6治疗。观察FK5 0 6的治疗效果、理想的治疗窗及毒副作用。 结果 :连续使用FK5 0 6的 2 6 8例患者中 ,肾功能 2～ 7天恢复正常者 198例 ,8～ 15天恢复正常者 4 4例 ,16～ 2 0天恢复正常者 2 1例 ,肾功能未恢复正常者 5例。发生急性排斥反应 (AR) 10 5 % (2 8/ 2 6 8) ,糖代谢紊乱 9 33% (2 5 / 2 6 8) ,神经系统功能紊乱 1 4 9% (4 / 2 6 8) ,肝功能异常 2 99%(8/ 2 6 8) ,肾中毒 1 87% (5 / 2 6 8) ,消化功能紊乱 17 5 % (4 7/ 2 6 8) ,巨细胞病毒 (CMV)血症 2 99% (8/ 2 6 8) ,肺部非CMV感染 1 4 9% (4 / 2 6 8)。脑出血死亡 0 37% (1/ 2 6 8) ,移植肾功能丧失、摘除移植肾 1 12 % (3/ 2 6 8)。FK5 0 6血药浓度为5～ 2 0 μg/L。 2 6例由CsA切换FK5 0 6治疗的耐激素性排斥反应患者中 ,有 2 3例肾功能 8～ 15天恢复正常 ,治愈率88 4 6 % (2 3/ 2 6 ) ,3例 2 8～
Objective:Tacrolimus (Prograf,FK506) is a new immune suppressive agent for anti rejection in organ transplantation.In this study,we report our experience in 294 renal allograft recipients who received tacrolimus regime,and evaluate the preventive and therapeutic effects of this regime on acute rejection in the early post transplantation period. Methodology:This is a retrospective analysis of 294 cadaveric renal allograft recipients(291 nales and 75 females,aged 19～76 years),among them 268 received tacrolimus regime 24 hours after the transplantation and 26 switched from cyclosporine A regime to the tacrolimus regime for methylprednisolone unresponsive acute rejection.The tacrolimus regime included tacrolimus [0 1 or 0 15 mg/(kg·d) with serum concentration between 8～10 μg/L or 10～20 μg/L],mycomephenite(500 mg,twice daily) and oral prednisone(20 mg/d for the first year and 10 mg/d for the years followed). Results:In the 268 recipients who started with the tacrolimus regime,28 had one episode of acute rejection in the first 20 days after renal transplantation,with a acute rejection rate of 10 5%.Side effects of this regime were observed,with hyperglycemia in 9 33%,never system disturbance in 1 49%,cytomegalovirus infection in 2 99% and non cytomegalovirus infection in 1 49% of the 268 patients.One patient died of cerebral hemorrhage in the first week after operation with recovered graft function,and two patients lost the graft for un recovered graft function.In the 26 recipients who switched from cyclosporine A regime because of steroid unresponsive acute rejection,graft function recovered in 23 within 32 days after the switch to tacrolimus regime. Conclusion:Tacrolimus regime is effective in the prevention and reversion of acute renal graft rejection.The side effects is tolerable in renal transplantation patients.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2003年第2期140-143,共4页
Chinese Journal of Nephrology,Dialysis & Transplantation
