摘要
目的探讨应用钙拮抗剂地尔硫卓(diltiazem,Dil)减少肾移植受者他克莫司(tacrolimus,Tac)用量并改善肾功能的可行性。方法肾移植术后3周,将Dil用于31例服用Tac的肾移植受者(Dil组),以未用Dil的22例为对照,检测Dil应用前和用后1周两组Tac血浓度谷值、受者淋巴细胞对供体树突状细胞的反应强度(LR);调整两组Tac血浓度在治疗窗范围内,观察两组术后6个月时LR,24个月时肌酐清除率(Ccr)降低值,两组急性排斥(AR)发生率和Tac用量。结果用Dil后1周,Dil组Tac血浓度平均升高57.2%,LR明显降低(7 709±1 257与9 965±1 908,P<0.01),与对照组上述指标变化差异无统计学意义(P>0.05)。术后6个月时两组LR差异无统计学意义(P>0.05)。术后24个月,Dil组Ccr降低值明显低于对照组为〔(27.5±9.2)mL/min与(34.7±8.2)mL/min,P<0.05〕。两组AR发生率差异无统计学意义(P>0.05),Dil组每例Tac总用量平均较对照组少443mg。结论Dil可显著提高肾移植后Tac免疫抑制效能并明显减少受者Tac用量;长期应用对移植肾功能具有保护作用。
Objective To explore the feasibility of reducing the dosage of tacrolimus （Tac） and improving renal function with diltiazem （DiL）in renal graft recipients. Methods Dil was used in 31 renal graft recipients with 22 renal graft recipients serverd as controls. The influence of Dil on trough level of Tac and recipient lymphocyte reaction （LR）to donor antigen were observed. The dosage of Tac and renal function were compared between the two groups in a two-year clinical trial. Results A significant increase of Tac trough level were observed in Dil group one week after the use of Dil〈（13.28±3.06）μg/L vs （8.45±2.38）ptg/L,P〈0. 013 with a signigicant decrease of LR （7 709±1 257 vs 9 965±1 908,P〈0.01）. The total Tac intake for each recipient in Dil group was 443mg less than that in the control on average. In the 24th month,the decrease of creatinine clearance in Dil group was significantly lower than that in the control [（27.5±9.2）mL/min vs （34.7±8.2）mL/min,P〈0. 053. The significant diference for the incidence of acute rejection was not observed between the two groups （P〉0.05）. Conclusion Administration of Dil may improve the immunosuppressive efficacy of Tac in renal graft reeipients,thus,a dosage reduction of Tac may be followed safely. And long term use of Dil may protect renal function as well.
出处
《重庆医学》
CAS
CSCD
2008年第14期1522-1524,共3页
Chongqing medicine
关键词
钙拮抗剂
他克莫司
肾功能
肾移植
calcium antagonist
tacrolimus
renal function
kidney transplantation
