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目的:探讨雷公藤多苷(TW)作为免疫抑制剂对肾移植患者长期存活率的疗效及副作用。方法:104例患者在肾移植术后采用TW+泼尼松(Pred)+环孢霉素(CsA)+硫唑嘌呤(AZa)免疫抑制剂治疗,48例患者在肾移植术后采用Pred+CsA+骁悉(MMF)免疫抑制剂治疗,就以下方面对两组患者进行观察比较:(1)术后5年内发生排斥反应及临界改变情况;(2)外周血白细胞下降、肝功能异常的发生率;(3)严重感染情况;(4)出现尿蛋白情况;(5)术后5年内肾功能变化情况及移植肾5年存活率。结果:5年内AZa+TW组急性排斥反应及临界改变的发生率较MMF组低,分别为11.5%、16.7%和4.8%、6.3%(P>0.05);GPT高于正常的发生率分别为7.7%、16.6%(P>0.05);外周血白细胞低于正常的发生率分别为0.96%、18.8%(P<0.01);严重感染的发生率分别为1.9%、18.8%(P<0.05),5年内出现蛋白尿的患者例数分别为17.3%、29.2%(P>0.05),两组移植肾5年存活率相似,分别为89.6%、85.4%(P>0.05)。结论:在肾移植术后应用CsA+Pred+AZa+TW免疫抑制方案是可行的,既可以使肾移植术后急性排斥反应减少,同时还能减少蛋白尿及慢性排斥反应的发生率下降,为国内提高移植肾长期存活率提供了一条新的途径。
Objective: To investigate the efficacy and side effects of Tripterygium glycosides (TW) as an immunosuppressive agent on long-term survival of renal transplant recipients. Methods: 104 patients received TW+ prednis + CsA + azathioprine (AZa) immunosuppressive agent after renal transplantation. 48 patients were treated with Pred+CsA+ after renal transplantation. In the treatment of immunosuppressive agents (MMF), the two groups of patients were compared in the following aspects: (1) rejection and critical changes occurred within 5 years after surgery; (2) incidence of leukopenia and abnormal liver function in peripheral blood (3) Severe infection; (4) Urinary protein; (5) Changes in renal function within 5 years after surgery and 5-year survival rate of transplanted kidney. Results: The incidence of acute rejection and critical change in the AZa+TW group was lower than the MMF group within 5 years (11.5%, 16.7%, 4.8%, 6.3%, respectively) (P>0.05); the incidence of GPT above normal was 7.7%, 16.6% (P>0.05); the incidence of peripheral blood leukocytes below normal was 0.96%, 18.8% (P <0.01); the incidence of severe infection was 1.9%, 18.8% (P <0.05) The number of patients who developed proteinuria within 5 years was 17.3% and 29.2%, respectively (P>0.05). The 5-year survival rates of transplanted kidneys in the two groups were similar, being 89.6% and 85.4%, respectively (P>0.05). Conclusion: The application of CsA+Pred+AZa+TW immunosuppressive regimen after renal transplantation is feasible, which can not only reduce the acute rejection after renal transplantation, but also reduce the incidence of proteinuria and chronic rejection. It has provided a new way to increase the long-term survival rate of transplanted kidney in China.