雷帕霉素靶蛋白抑制剂对肾移植患者血尿酸水平的影响。

The effects of mammalian target of rapamycin inhibitors on serum uric acid levels in renal transplant patients.

机构信息

Division of Nephrology, Ege University, School of Medicine, 35100 Bornova, Izmir, Turkey.

出版信息

Int Urol Nephrol. 2013 Apr;45(2):547-52. doi: 10.1007/s11255-012-0214-0. Epub 2012 Jun 30.

Abstract

BACKGROUNDS/AIMS: Elevated uric acid (UA) levels are frequently observed after renal transplantation. We investigated the consequences of shifting from calcineurin inhibitors (CNI) to mammalian target of rapamycin inhibitors (mTORi) on UA levels and graft functions.

METHODS

Ninety-six patients were enrolled. Main points of interest were changes in UA and glomerular filtration rate (GFR).

RESULTS

Mean age of the whole population was 39 ± 11 years (18-73), and 64.2 % were male. Patients were stratified into two groups according to their CNI type prior to the switch as cyclosporin A (CsA) or tacrolimus (Tac). Patients that were switched from CsA had a mean GFR of 49 ± 18 ml/min and serum UA level of 7.4 ± 1.8 mg/dl at the pre-switch period. Mean GFR increased to 53 ± 22 ml/min (p = 0.03), and UA levels decreased to 6.2 ± 1.6 mg/dl at the final visit (p < 0.001). In the Tac group, pre-switch mean GFR was 59 ± 28 ml/min and serum UA level 6.6 ± 2.6 mg/dl. In this group, mean GFR increased to 63 ± 28 ml/min (p = 0.03) and UA levels decreased to 6.2 ± 2.1 at the last visit (p < 0.001).

CONCLUSION

Switch from CNI to mTORi-based regimen provides better control of UA levels and improves renal functions.

摘要

背景/目的：肾移植后常观察到尿酸（UA）水平升高。我们研究了从钙调神经磷酸酶抑制剂（CNI）转换为雷帕霉素靶蛋白抑制剂（mTORi）对 UA 水平和移植物功能的影响。

方法

共纳入 96 例患者。主要观察指标为 UA 和肾小球滤过率（GFR）的变化。

结果

全人群平均年龄为 39 ± 11 岁（18-73 岁），男性占 64.2%。根据转换前 CNI 类型将患者分为环孢素 A（CsA）或他克莫司（Tac）两组。从 CsA 转换的患者在转换前的 GFR 为 49 ± 18 ml/min，UA 水平为 7.4 ± 1.8 mg/dl。最终随访时 GFR 增加至 53 ± 22 ml/min（p = 0.03），UA 水平降低至 6.2 ± 1.6 mg/dl（p < 0.001）。在 Tac 组中，转换前 GFR 为 59 ± 28 ml/min，UA 水平为 6.6 ± 2.6 mg/dl。在该组中，GFR 增加至 63 ± 28 ml/min（p = 0.03），UA 水平降低至最后一次就诊时的 6.2 ± 2.1（p < 0.001）。