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目的探讨肾移植受者在以环孢素为基础的免疫抑制剂方案治疗期间发生药源性疾病(DID)后,将环孢素切换为他克莫司后对疗效的影响。方法通过收集92例将环孢素切换为他克莫司的肾移植受者的临床资料,分析切换后1年内环孢素所致DID改善的情况。结果与未切换方案时相比,发生急性排异反应(AR)和爬行肌酐(CScr)的肾移植受者在切换方案后1、3、6和12个月的血肌酐(Scr)和尿素氮(BUN)均下降(P<0.05或0.01);发生药物性肝损伤(DILI)者在切换方案后1、3、6和12个月的直接胆红素(DB)、总胆红素(TB)均下降(P<0.05或0.01),在切换方案后12个月时谷丙转氨酶(ALT)降低(P<0.05);牙龈增生(GH)在切换方案1个月后逐渐消失。但切换方案后肾移植受者空腹血糖(FPG)却逐渐升高,并在12个月时显著升高(P<0.05)。结论血糖正常的肾移植受者,如发生与环孢素有关的AR、CScr、DILI和(或)GH等严重DID,将环孢素切换为他克莫司,可有效提高肾移植受者的生存质量和生存期。
Objective To investigate the effect of cyclosporine switching to tacrolimus after renal transplant recipients develop drug-induced disease (DID) during cyclosporine-based immunosuppressive regimens. Methods The clinical data of 92 renal transplant recipients who switched cyclosporine to tacrolimus were collected and analyzed for cyclosporine-induced DID improvement within 1 year after switching. Results The renal transplant recipients who experienced acute rejection (AR) and reptile creatinine (CScr) had higher serum creatinine (Scr) and urea nitrogen at 1, 3, 6 and 12 months after switching regimen (BUN) were decreased (P <0.05 or 0.01). In patients with DILI, the direct bilirubin (DB), total bilirubin (TB) ) Decreased (P <0.05 or 0.01). ALT decreased (P <0.05) at 12 months after switching regimen; gingival hyperplasia (GH) gradually disappeared one month after switching regimen. However, fasting plasma glucose (FPG) was gradually increased in the transplant recipients and significantly increased at 12 months (P <0.05). Conclusions In patients with normal blood glucose, renal transplant recipients who develop cyclosporine-related AR, CScr, DILI, and / or GH and other severe DIDs will be able to switch cyclosporine to tacrolimus Quality of life and survival.