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目的 :观察他克莫司 (FK5 0 6)替换环孢素A (CsA)治疗移植肾慢性排斥反应的效果。方法 :选择肾移植术后肾功能异常 ,并经移植肾穿刺活检病理证实为慢性排斥反应者 6例 ,用FK5 0 6替换CsA ,其他免疫抑制剂未作更动 ,起始剂量为 0 1mg·kg-1·d-1 ,以后根据血中FK5 0 6的浓度加以调整 ,维持谷值浓度在 5～ 10ug/L。治疗期间观察患者血压、血脂、蛋白尿、血肌酐、肾小球滤过率变化情况。结果 :FK 5 0 6替换CsA ,随访 6～ 2 2个月 ,平均 13个月 ,4例患者移植肾功能得到明显改善 ,并持续稳定 ,蛋白尿基本消失 ;1例肾功能改善 (血肌酐下降程度 >2 0 %) ,蛋白尿减轻 ;5例患者血压均有不同程度下降 ,其中 2例已停用降压药 ,血脂下降不明显 ;1例治疗无效 ,血肌酐渐进升高 ,蛋白尿加重。治疗期间未发生急性排斥反应和肝功能损害。结论 :对于移植肾慢性排斥反应的早期 ,用FK 5 0 6替换CsA对延缓肾功能衰竭的进程是安全有效的。
Objective: To observe the effect of tacrolimus (FK506) replacement cyclosporin A (CsA) on chronic rejection of renal allograft. Methods: Six cases of renal allograft after renal transplantation were selected and pathologically confirmed as chronic rejection by transplanted renal biopsy. CsA was replaced by FK5 0 6, and other immunosuppressive agents were unchanged. The initial dose was 0 1 mg · kg-1 · d-1, later adjusted according to the concentration of FK506 in the blood to maintain the trough concentration of 5 ~ 10ug / L. During treatment, blood pressure, blood lipid, proteinuria, serum creatinine and glomerular filtration rate were observed. Results: FK506 replaced CsA for a mean follow-up of 6 to 22 months with an average of 13 months. The renal function was significantly improved in 4 patients and remained stable with minimal proteinuria. One patient had an improvement in renal function (decreased serum creatinine Degree of> 20%), proteinuria decreased; 5 patients with varying degrees of decline in blood pressure, of which 2 patients had antihypertensive drugs disabled, blood lipids decreased significantly; 1 case of ineffective treatment, progressive increase in serum creatinine, increased proteinuria . No acute rejection and liver dysfunction occurred during the treatment. Conclusion: In the early stage of chronic rejection of renal allografts, replacing CsA with FK506 is safe and effective in retarding the progression of renal failure.