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目的:了解减少或停用神经钙蛋白阻滞药能否改善肾移植后慢性移植物肾病患者的肾功能。方法:1999年1月-2001年5月期间,对病理诊断为慢性移植物肾病(Ⅰ级)肾功不全的93例肾移植患者随机分为A、B两组,A组(50例):在1-2周内将其神经钙蛋白阻滞药(环孢素或他克莫司)减少至原剂量的三分之一或完全停用,同时适当增加硫唑嘌呤或霉酚酸脂的用量;B组(43例):环孢素A或他克莫司未作大幅度减量、而是仅适当增加硫唑嘌呤或霉酚酸脂的用量。对两组患者进行至少3年的随访,比较其移植肾功能、观察两组急性排斥反应有无差异等。结果:3年后A组有31例(62.O％)患者移植肾功能得以好转或不再继续恶化,而B组除4例(9.3％)移植肾功能维持在原有水平外,其他患者肾功能均进行性恶化;3年后A组肾功能明显好于B组;B组3年后尿蛋白定量明显增多,而A组无明显改变;两组急性排斥反应发生率无显著差异。结论:大幅度减少甚至停用神经钙蛋白阻滞药可使部分肾移植后慢性移植物肾病惠者的肾功能得以改善或者阻止其进行性恶化。这种药物调整是安全的。
OBJECTIVES: To investigate whether reducing or discontinuing calcineurin can improve renal function in patients with chronic allograft nephropathy after kidney transplantation. Methods: From January 1999 to May 2001, 93 renal transplant recipients with pathologically diagnosed chronic graft nephropathy (grade Ⅰ) with renal insufficiency were randomly divided into A and B groups. Group A (n = 50) Reduce its calcineurin blocker (ciclosporin or tacrolimus) to one-third of the original dose or discontinue it altogether in 1-2 weeks with a corresponding increase in the concentration of azathioprine or mycophenolate B group (43 cases): Cyclosporine A or tacrolimus was not significantly reduced, but only appropriate to increase the amount of azathioprine or mycophenolic acid. The patients in both groups were followed up for at least 3 years to compare their renal function and observe the difference of acute rejection between the two groups. Results: After 3 years, 31 patients (62.0%) in group A got better or no further deterioration of renal function, and 4 patients (9.3%) in group B maintained their renal function beyond their original level. Other patients’ kidney 3 years later, the renal function of group A was significantly better than that of group B. The proteinuria of urinary protein in group B was significantly increased after 3 years, while there was no significant change in group A; There was no significant difference in the incidence of acute rejection between the two groups. CONCLUSIONS: Significant reductions or even discontinuations of calcineurin may improve or prevent the progressive worsening of renal function in patients with chronic allograft kidney disease after partial renal transplantation. This medication adjustment is safe.