Kootte A M, Lensen L M, van Bockel J H, van Es L A, Paul L C
Department of Nephrology, University Hospital Leiden, The Netherlands.
Nephrol Dial Transplant. 1988;3(5):666-70. doi: 10.1093/oxfordjournals.ndt.a091725.
The immunosuppressive effectiveness and nephrotoxic side-effects of either high-dose cyclosporin (CsA) (16 mg/kg per day) or low-dose (9 mg/kg per day) in combination with azathioprine (Aza) (1 mg/kg per day) were studied in 80 renal transplant patients who also received low-dose corticosteroids. At 3 months, patients who received high-dose CsA were randomly assigned to either continuation of CsA or conversion to Aza, whereas in the triple-therapy group either CsA or Aza was discontinued. No differences in patient (97.5%) or graft survival (90%-92.5%) were found at 1 year. There were no differences in the incidence of primary non-functioning kidneys. The incidence of acute rejection episodes was 45% in the high-dose CsA group and 55% in the group treated with low CsA doses together with Aza (not significant). At 3 months the mean creatinine clearance was 60 +/- 4 ml/min (mean +/- SEM) in the high-dose group (mean cumulative CsA dose 0.96 g/kg) compared with 55 +/- 3 ml/min in the low-dose group (mean cumulative CsA dose 0.60 g/kg). At 1 year no differences in the degree of proteinuria or the incidence of hypertension was found between the different groups. The best mean creatinine clearance at 1 year (77 +/- 5 ml/min) was found in patients who received high doses of CsA for 3 months followed by conversion.
在80例同时接受小剂量皮质类固醇治疗的肾移植患者中，研究了高剂量环孢素（CsA）（每天16mg/kg）或低剂量（每天9mg/kg）联合硫唑嘌呤（Aza）（每天1mg/kg）的免疫抑制效果和肾毒性副作用。3个月时，接受高剂量CsA的患者被随机分配继续使用CsA或转换为使用Aza，而在三联疗法组中，CsA或Aza被停用。1年时，患者存活率（97.5%）或移植物存活率（90%-92.5%）无差异。原发性无功能肾的发生率无差异。高剂量CsA组急性排斥反应的发生率为45%，低剂量CsA联合Aza治疗组为55%（无显著差异）。3个月时，高剂量组平均肌酐清除率为60±4ml/分钟（平均值±标准误）（CsA平均累积剂量0.96g/kg），而低剂量组为55±3ml/分钟（CsA平均累积剂量0.60g/kg）。1年时，不同组之间蛋白尿程度或高血压发生率无差异。1年时平均肌酐清除率最佳（77±5ml/分钟）的是那些接受高剂量CsA治疗3个月后转换治疗的患者。
