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目的:肾移植术后环孢素A和皮质醇联合应用可使患者发生高脂血症的风险升高,观察在此基础上应用硫唑嘌呤和霉酚酸酯对肾移植患者血脂的影响。方法:选择2003-01/2006-01解放军第四军医大学西京医院泌尿外科收治的肾移植患者65例,患者均知情同意。①实验分组及方法:按服用免疫抑制剂不同将患者分为2组,硫唑嘌呤组35例,霉酚酸酯组30例。患者肾移植术后1年内均以环孢素A和皮质醇为基础免疫抑制治疗方案,免疫抑制方案始终为环孢素A+硫唑嘌呤+皮质醇或环孢素A+霉酚酸酯+皮质醇。②实验评估:检测两组患者术前、术后3个月、个月及12个月的血脂指标,包括总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密6度脂蛋白胆固醇和极低密度脂蛋白胆固醇,同时检测血清肌酐水平。结果:65例患者全部进入结果分析,无脱落。①术前患者高脂血症的发生率是35.2%,至术后第3个月为62.7%,术后第6个月为52.3%,术后第12个月为39.3%。②术后1年中两组患者的总胆固醇和三酰甘油水平均较术前显著升高(P<0.05),术后第3个月时霉酚酸酯组的总胆固醇水平显著高于硫唑嘌呤组(P<0.05),但在第6个月以后,两组间总胆固醇与三酰甘油水平差异无显著性意义(P>0.05)。在1年的监测中,两组患者的高密度脂蛋白、低密度脂蛋白和极低密度脂蛋白水平皆未发生显著变化(P>0.05)。结论:在以环孢素和皮质激素为基础免疫抑制方案的肾移植患者中,血清总胆固醇和三酰甘油有明显的升高倾向,而这种升高倾向可能与长期服用硫唑嘌呤或霉酚酸酯无关。
OBJECTIVE: The combined use of cyclosporine A and cortisol after renal transplantation may increase the risk of developing hyperlipidemia in patients. The effects of azathioprine and mycophenolate mofetil on the blood lipids in renal transplant recipients were observed. Methods: Totally 65 renal transplant recipients were enrolled from Department of Urology, Xijing Hospital, Fourth Military Medical University from January 2003 to January 2006. All patients received informed consent. ① experimental grouping and methods: according to taking different immunosuppressive agents the patients were divided into two groups, 35 cases of azathioprine, mycophenolate mofetil 30 cases. Cyclosporin A and cortisol were used as the basis of immunosuppressive therapy in patients within 1 year after renal transplantation. The immunosuppressive regimen was always cyclosporine A + azathioprine + cortisol or cyclosporin A + mycophenolate + cortisol . ② Experimental evaluation: The blood lipid indexes of three groups including total cholesterol, triglyceride, high density lipoprotein cholesterol, low density 6-lipoprotein cholesterol, Low density lipoprotein cholesterol, serum creatinine levels were measured at the same time. Results: All 65 patients entered the result analysis without shedding. ① The preoperative incidence of hyperlipidemia was 35.2%, 62.7% in the third month after operation, 52.3% in the sixth month after operation and 39.3% in the twelfth month after operation. ② The level of total cholesterol and triglyceride in both groups were significantly higher than those before operation (P <0.05) at 1 year after operation. The level of total cholesterol in mycophenolate mofetil group was significantly higher than that at the 3rd month after operation (P <0.05). However, there was no significant difference in total cholesterol and triglyceride between the two groups after 6 months (P> 0.05). During the one-year monitoring, there was no significant change in the levels of HDL, LDL and VLDL in both groups (P> 0.05). CONCLUSIONS: Serum total cholesterol and triglyceride tended to increase significantly in renal transplant recipients who received cyclosporine and corticosteroid-based immunosuppression and may be associated with long-term use of azathioprine or mildew Phenolic ester has nothing to do.