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目的 :探讨他克莫司 (FK5 0 6 )治疗急性加速性排斥反应 (AAR)的疗效及副作用。 方法 :5例患者在肾移植术后 5天内经移植肾活检发现均存在血管内膜炎、小管炎及小球炎。将患者环孢素A(CsA)切换为FK5 0 6 ,并给予行连续性静脉 静脉血液滤过 (CVVH)。 结果 :FK5 0 6起始剂量为 1 5mg/ (kg d) ,调整剂量 ,使FK5 0 6谷值浓度维持在 5～ 15ng/ml之间。在给予FK5 0 6治疗 10～ 19天后患者血肌酐 (SCr)开始下降 ,治疗 2 0～ 39天后SCr降至正常或稳定在 134～ 15 7μmol/L之间。患者少尿过程中均给予CBP治疗 ,无一例出现心衰、肺水肿及电解质紊乱。 3例患者分别在间隔 6、6、2个月后行重复活检术 ,组织学结果提示肾小球炎、间质小管炎及血管内膜炎较前有明显好转。 结论 :FK5 0 6联合CVVH治疗能有效逆转移植肾AAR。
Objective: To investigate the efficacy and side effects of FK506 in the treatment of acute accelerated rejection (AAR). Methods: Five patients were found to have endocarditis, tubulitis and small ballitis by transplanted renal biopsy within 5 days after renal transplantation. Patient cyclosporin A (CsA) was switched to FK5 0 6 and given continuous venous venous hemofiltration (CVVH). Results: The initial dose of FK506 was 15 mg / (kg d), and the dosage of FK506 was kept at 5 ~ 15 ng / ml. Serum creatinine (SCr) began to decline after 10 to 19 days of treatment with FK506, and decreased to normal or stable between 134 and 157 μmol / L after 20 to 39 days of treatment. Patients with oliguria were given CBP treatment, no case of heart failure, pulmonary edema and electrolyte imbalance. Three patients underwent repeat biopsy at intervals of 6, 6, and 2 months respectively. The histological findings suggested that glomerulitis, interstitial tubulitis and endocarditis were significantly improved compared with those before. Conclusion: FK5 06 combined with CVVH can effectively reverse AAR in renal allografts.