肾移植术后肝功能异常患者用他克莫司替换环孢素A疗效的初步观察

摘要

目的 观察他克莫司(FK506) 替换环孢素A(CsA)并联合应用霉酚酸酯(MMF)及泼尼松(Pred)防治肾移植术后肝功能异常患者的有效性及安全性.方法 肾移植术后8例肝功能异常患者(男性5例,女性3例,平均38.23岁),用FK506替换CsA治疗,停用CsA24h后,开始给予FK506.FK506初始剂量根据患者体重、肝功能损害程度及术后时间确定,服药1周后,根据全血FKS06谷值浓度调整剂量,使其谷值浓度维持于5～15μg/L.结果 用FK506替换CsA,1个月后患者血中直接胆红素从替换前的(22.66±17.19)μmnol/L下降至(7.05±2.32)/μmol/L,P＜0.05;间接胆红素从替换前的(42.15±34.15)μmol/L下降至(14.54±2.59)μmol/L,P＜0.05;血清丙氨酸转氨酶从替换前的(83.00±93.14)IU/L下降至1个月后的(29.50±15.41)IU/L,P＞0.05;血清肌酐从(177.91±86.41)μmol/L下降至(135.92±34.05)μmol/L,P＞0.05.3例腹水的患者均于药物替换 1个月后完全消失.仅有1例患者出现便秘、食欲下降伴上肢颤抖.结论 用FK506 替换 CsA 并联合应用MMF及Pred 对防治肾移植术后肝功能异常是安全和有效的措施.%Objective To evaluate the efficacy and safety of CsA substituted by tacrolimus(FK506) combined with MMF and prednisone in prevention of rejection in renal transplant recipents with hepatic dysfunction. Methods Eight patients with hepatic dysfunction received the treatment of FK506 substituting for CsA. FK506 was administeted at least 24 h after the last dose of cyclosporine.The initial dose of FK506 was based on body weight,the degree of hepatic dysfunetion and the period after operation of the patients.After administration of one week.the dose of FK506 was subsequently adjusted to maintain its whole blood trough levels between 5～15μg/L. Results Substitute of tacrolimus for cycbsporin resulted in a markedly reduced blood index,direct-bilirubin from(22.66±17.19)μmol/L to(7.05±2.32)μmol/L(P＜0.05), indirect-bilirubin from(42.15±34.15)μmol/L to(14.54±2.59)μmol/L(P＜0.05), sAL T from (83.00±93,14)IU/L to(29,50±15.41)IU/L(P＞0.05),Cr from (177.91±86.41)μmol/L to(135.92±34.05)μmol/L(P＞0.05)in one month.The ascites of 3 patients disappeared in one month. Astriction,anorexia,upper limbs trembling appeared only in one patient.Conclusion It is effective and safe to substitute CsA by FK506 combined with MMF and prednisone in prevention of rejection in renal transplant recipients with hepatic dvsfunction.