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目的 :了解环孢素 A在肾移植患者肝功能受损中的作用和长期服用对患者的影响。方法 :回顾性分析了 3组资料 :(1) 1978年 7月至 1984年应用二联免疫抑制治疗 (硫唑嘌呤 +泼尼松 )的肾移植患者 83例 ,1985～ 1991年应用三联免疫抑制治疗 (环孢素 A+硫唑嘌呤 +泼尼松 )的肾移植患者 5 80例 ;(2 ) 1994年 1月至 1997年 8月进行的肾移植患者 5 19例 ;(3)随访服用环孢素 A免疫抑制治疗 8年以上患者 6 8例 ,10年以上 32例。结果 :(1)二联免疫抑制治疗组肝功能受损发生率为 14.5 % (12 / 83) ,三联免疫抑制治疗组为 2 6 .0 % (15 0 / 5 80 ) ,两者比较有明显差异 (χ2 =5 .114,P<0 .0 5 ) ,表明三联免疫抑制治疗发生肝功能受损的比例高于二联免疫抑制治疗 ;(2 ) 5 19例肾移植患者中发生肝功能严重损害 30例 (5 .8% ) ,有 HBV、HCV感染者 2 8例 ,占 93.3% (2 8/ 30 )。其中血清 HBs Ag阳性 11例 (36 .6 % ) ,HCV RNA阳性 12例 (4 0 % ) ,HBs Ag和 HCV RNA均阳性 5例。 (3)随访服用环孢素 A8年以上的 10 0例患者中 ,仅发现 1例肝硬化患者。结论 :环孢素 A具有一定的肝毒性 ,一般程度较轻 ,经调整用药后容易恢复。但环孢素 A在 HBV、HCV感染的基础上易加重肝脏的损害。长期服用环孢素 A较为安全 ,且免疫抑制效果稳?
Objective: To understand the role of cyclosporine A in impaired liver function in renal transplant recipients and the impact of long-term use on patients. METHODS: Three sets of data were retrospectively analyzed: (1) 83 renal transplant recipients with dual immunosuppression (azathioprine + prednisone) from July 1978 to 1984 were enrolled in this study. From 1985 to 1991, triple immunosuppression Treatment of CsA (cyclosporin A + azathioprine + prednisone) in 588 patients with renal transplantation; (2) January 1994 to August 1997 in renal transplant patients 519 cases; (3) follow-up taking cyclosporine Sixty-eight patients were treated with a-immunosuppressive therapy for more than 8 years and 32 patients were over 10 years old. Results: (1) The incidence of liver dysfunction was 14.5% (12/83) in the immunosuppressive group and 26.0% (15 0/80) in the triple immunosuppressive group, which were more obvious (Χ2 = 5.114, P <0.05), indicating that the proportion of patients with impaired hepatic function in triple immunosuppressive therapy was higher than that of immunosuppressive therapy. (2) Serious hepatic function occurred in 519 renal transplant patients There were 30 cases (5.8%) with HBV and HCV infection, accounting for 93.3% (28/30). Serum HBs Ag positive in 11 cases (36.6%), HCV RNA-positive in 12 cases (40%), HBs Ag and HCV RNA were positive in 5 cases. (3) Of the 100 patients who were followed up for cyclosporine A for 8 years, only 1 patient with cirrhosis was found. Conclusion: Cyclosporine A has some hepatotoxicity, generally mild, easy to recover after adjusting medication. However, cyclosporin A in HBV, HCV infection based on the easy to aggravate the liver damage. Long-term use of cyclosporin A more secure, and immunosuppressive effect stable?