摘要
目的探讨新型免疫抑制剂他克莫司 (FK5 0 6 )在移植肾肾功能延迟恢复 (DGF)受者中的应用价值与合理用药方案。方法对 6 2例DGF受者术后早期的免疫抑制方案进行前瞻性对比研究 ,首先以抗淋巴细胞球蛋白 (ALG)诱导免疫抑制 10d ,继而在ALG治疗结束前 3～ 4d分别应用环孢菌素A(CsA ,n =2 8)或FK5 0 6 (n =34 )为基础的维持方案 (CsA/FK5 0 6 +MMF +pred) ,评估两组移植肾肾功能恢复状况、急性排斥反应和不良反应发生率。结果FK5 0 6组 34例术后 5 0d内肾功能均恢复正常 ,根据个体化原则调整FK5 0 6用药剂量和血药浓度 ,术后 8周内血药浓度维持于 6～ 9μg/L ;CsA组术后 8周内有 2 5例肾功能基本恢复 ,维持CsA血药浓度谷值 2 0 0～ 30 0 μg/L ,峰值浓度 10 0 0～ 130 0 μg/L ;两组均未观察有急性排斥反应发生。CsA组肝功能异常(转氨酶升高 )显著增加 (P <0 .0 5 )。结论在肾移植术后DGF受者中 ,经ALG诱导治疗后 ,早期序贯应用以FK5 0 6 (6 .0～ 9.0 μg/L)。
ObjectivesTo evaluate and find out the rational project for administration of new Immuno-suppressant tacrolimus (FK506) in renal transplant recipients with delayed graft function (DGF) .MethodsProspective trial of immunosuppressive project in sixty-two cases of renal transplant recipients with DGF was comparatively studied during early postoperative period. Immunosuppressive therapy was induced with anti-lymphocyte globulin (ALG) for first 10 days; subsequently,3～4 days before the termination of ALG therapy 28 patients were treated by maintenance project based on cyclosporine A(CsA) or 34 patients treated by that based on FK506 [CsA/FK506+mycophenolate mofetil (MMF)+pred], respectively. The initial dosage of cyclosporine A was 5～7 mg·kg -1·d -1 and that of FK506 was 0.1～0.2 mg·kg -1·d -1, the trough serum levels of FK506 were adjusted to maintain around 6.0～ 9.0 μg/L. The recovery of renal function, acute rejection episode and rate of side effects in both groups were assessed.ResultsThe renal function of 34 patients in FK506 group returned to normal within 50 days after operation .Having adjusted the dosage and blood levels of FK506 according to principle of individualization, their blood levels were kept on 6～9 μg/L within 8 wks after operation. The renal function in 25 out of 28 patients from CsA group recovered essentially within 8 wks after operation; their blood levels of CsA were maintained on 200～300 μg/L, with a peak level of 1000～1300 μg/L. Acute rejection episodes were not observed in both groups.The cases with abnormal liver function (e.g. elevated transaminase activity) obviously increased in CsA group (P<0.05).ConclusionApplication of the combined immunosuppressive regime based on tacrolimus is more preferable for renal transplant recipients with DGF during the early postoperative period. Maintenance of its trough concentration on a lower level (6.0～9.0 μg/L) through insistence on individualized drug administration would be beneficial to the recovery of renal function and reduction of toxic side effects.
出处
《医学临床研究》
CAS
2003年第10期756-759,共4页
Journal of Clinical Research
