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目的 :探讨调整免疫抑制药的使用方案能否改善肾移植后慢性移植物肾病患者的肾功能。方法 :对 32例 (A组 )慢性移植物肾病早期肾功不全的患者在 1～ 2周内将其神经钙蛋白阻滞药 (环孢素A或他克莫司 )减少至原剂量的 1/ 3或完全停用 ,同时适当增加硫唑嘌呤或霉酚酸酯 (MMF)的用量 ,与同期内环孢素A或他克莫司未作大幅度减量、仅适当增加硫唑嘌呤或霉酚酸酯用量的 2 6例 (B组 )慢性移植物肾病患者进行对比 ,随访比较两组的移植肾功能 ,观察急性排斥反应情况。结果 :1年后A组有 2 1例 (6 5 .6 % )患者移植肾功能得以好转或不再继续恶化 ,而B组除 3例 (11.5 % )移植肾功能维持在原有水平外 ,其他患者肾功能均进行性恶化。两组急性排斥反应发生率无显著差异。结论 :大幅度减少甚至停用神经钙蛋白阻滞药可使部分肾移植后慢性移植物肾病患者的肾功能得以改善或者防止其进行性恶化。这种药物调整是安全的。
Objective: To investigate whether adjusting the use of immunosuppressive drugs can improve renal function in patients with chronic allograft nephropathy after renal transplantation. Methods: Thirty-two patients (group A) with chronic renal failure of early renal insufficiency underwent 1 to 2 weeks of neurasthenic blockade (ciclosporin A or tacrolimus) to the original dose of 1 / 3 or completely disabled, while appropriate increase in the amount of azathioprine or mycophenolate mofetil (MMF), cyclosporine A or tacrolimus over the same period did not make significant reductions, only appropriate to increase azathioprine or Mycophenolates in 26 patients (group B) with chronic graft-versus-kidney disease were compared. The renal function of the two groups were followed up and observed for acute rejection. Results: After 1 year, 21 cases (65.6%) in group A got better or no further deterioration of renal function, while 3 cases (11.5%) in group B maintained renal function beyond their original level. Other Patients with renal function were progressive deterioration. There was no significant difference in the incidence of acute rejection between the two groups. CONCLUSIONS: A significant reduction or even discontinuation of calcineurin can improve or prevent the progressive deterioration of renal function in patients with chronic allograft nephropathy after partial renal transplantation. This medication adjustment is safe.