Objective To evaluate the safety and efficacy of conversion from tacrolimus to cyclosporine A therapy in treatment of new-onset diabetes after kidney transplantation( NODAT) . Methods Of 221 kidney transplant recipients, 51 patients developed NODAT (23%) and divided into 3 groups:cyclosporine A conversion therapy group (group A,n=23),standard tacrolimus reduction therapy group(group B,n=17),and oral hypoglycemic drugs group(group C,n=11). All the patients received dietary and exercise therapies. Insulin were injected in patients with postprandial 2 h blood glucose over 14. 0 mmol/L. The patients were followed up regularly for 3 years. Results The mean blood glucose level was (13. 35 ± 1. 59) mmol/L upon the diagnosis of NODAT in the 51 patients, and there was no significant difference among the three groups(P>0. 05). The fasting plasma glucose levels in three groups were decreased at 4 month after therapy, and the glycosylated hemoglobin levels in three groups were decreased significantly at 8 month after therapy. At 12 month, the blood glucose and the glycosylated hemoglobin became normal in both groups A and B, but there was no significant difference between groups A and B(P>0. 05). The blood glucose and the glycosylated hemoglobin decreased at 12 month in group C, but there was significant difference between group C and group A. The daily insulin dose was higher in group B than in group A( P<0. 05). The mean serum creatinine and the cystatin-C level showed no significant difference in groups A and B after followed up for three years(P>0. 05), but they were increased after medication with oral hypoglycemic drugs in group C(P<0. 05). After followed up for 3 years, the patient and graft survival rates were 100% and 95. 6% in group A, 100% and 94. 1% in group B,100% and 94. 1% in group C. The patient and graft survival rates were lower in group C than groups A and B(P<0. 05). Conclusion Conver-sion from tacrolimus to cyclosporine A therapy can significantly improve the metabolism of patients with NODAT, and is safe within three years.%目的：评价他克莫司转换为环孢素A治疗肾移植术后糖尿病的安全性及疗效。方法回顾性分析我院2008-06~2014-06术后规律随访的221例肾移植术后患者,其中有51例(23%)诊断为肾移植术后新发糖尿病,按治疗方案分为三组：A组(环孢素转换组,n=23)他克莫司转换为环孢素方案；B组(他克莫司减量组,n=17)为标准化的他克莫司减量方案；C组(口服降糖药物组,n=11)免疫抑制剂方案不变,予以口服降糖药物,所有患者均辅助饮食及运动疗法。当餐后血糖超过14.0 mmol/L时,餐前辅助皮下注射短效胰岛素治疗,并规律随访3年。结果所有入组患者诊断肾移植术后糖尿病时血糖平均为(13.35±1.59)mmol/L,三组间差异无显著性(P>0.05)。经辅助治疗4月后,三组患者空腹血糖均下降；治疗8个月后,三组糖化血红蛋白下降明显；经调整胰岛素剂量12月后,A组和B组患者空腹血糖及糖化血红蛋白均降至正常,两组间差异无显著性(P>0.05),C组空腹血糖和糖化血红蛋白降低,与A组比较差异有统计学意义(P<0.05)。但日均胰岛素用量,B组患者明显多于A组(P<0.05)。 A组和B组治疗3年后肌酐及胱抑素-C较治疗前变化不大(P>0.05)；C组患者治疗3年后肌酐及胱抑素-C上升(P<0.05)。 A、B、C三组患者3年人/肾生存率分别是100%和95.6%,100%和94.1%,81.8%和72.7%,A组与C组间差异有统计学意义(P<0.05)。结论肾移植术后糖尿病患者将他克莫司转换为环孢素有利于血糖控制,转换后(3年内)移植肾功能稳定。
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