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吗替麦考酚酯免疫抑制基于 CNI 减少对肺移植后 CNI 相关肾损伤的影响。

Effect of MMF Immunosuppression Based on CNI Reduction on CNI-Related Renal Damage after Lung Transplantation.

机构信息

Special Needs Section, Jiangsu Wuxi People's Hospital, Wuxi 214000, China.

The Second People's Hospital Affiliated to Nanjing Medical University, Nanjing 210005, China.

出版信息

J Healthc Eng. 2022 Jan 25;2022:8099684. doi: 10.1155/2022/8099684. eCollection 2022.

Abstract

In this paper, numerous effects of immunosuppressive regimen of mycophenolate mofetil (MMF) on CNI-related renal damage after lung transplantation are evaluated thoroughly. For this purpose, 110 lung transplant recipients who were treated in our hospital from March 2016 to January 2018 were randomly selected. All patients took prednisone acetate tablets or rapamycin at the same time or not at the same time. MMF is 1 g every time, twice a day, and adjusted according to the re-examination. According to the different drugs taken by 110 patients, they were divided into cyclosporine A group and tacrolimus group. Among them, 92 patients in cyclosporine A group took cyclosporine A; 18 patients in tacrolimus group took tacrolimus. The clinical data of age and gender of the two groups were collected, To observe and compare the occurrence of CNI-related renal damage in lung transplant recipients and different immunosuppressants. The CNI dosage of tacrolimus group and cyclosporine A group was compared before and after MMF. The changes of serum creatinine level and serum creatinine clearance rate were measured before MMF administration and 30, 60, and 90 days after MMF administration, to observe the complications of CNI-related renal damage after lung transplantation. Experimental results showed that there were 16 cases (14.55%) of CNI-related renal damage in lung transplant recipients and different immunosuppressants, including 10 cases (11.36%) in males, 6 cases (27.27%) in females, 11 cases (12.09%) in tacrolimus group, and 5 cases (26.32%) in cyclosporine A group. There was no significant difference between the two groups ( > 0.05). Compared with MMF before and after administration, CNI dosage of cyclosporine A group and tacrolimus group decreased significantly ( < 0.01). Compared with MMF before administration, serum creatinine level decreased and serum creatinine clearance rate increased significantly ( < 0.05). In the follow-up, 16 patients with CNI-related renal damage were found to be immune rejection before the adjustment of immunosuppression program, no complications such as immune rejection, myelosuppression, and infection occurred within 15 months after the adjustment of immunosuppression program, blood glucose increased in 3 patients within 2 years after operation, blood lipid increased in 1 patient, urea increased in 1 patient, and uric acid increased in 1 patient. MMF immunosuppressive therapy based on CNI reduction is a safe and effective immunosuppressive therapy, which can significantly reduce immune rejection, improve renal function, and play an important role in improving CNI-related renal damage after lung transplantation.

摘要

本文全面评估了霉酚酸酯(MMF)免疫抑制方案对肺移植后钙调神经磷酸酶抑制剂(CNI)相关肾损伤的诸多影响。为此,我们随机选择了 2016 年 3 月至 2018 年 1 月在我院接受治疗的 110 例肺移植受者。所有患者同时或不同时服用醋酸泼尼松龙片或雷帕霉素。MMF 每次 1g,每天两次,并根据复查情况进行调整。根据 110 例患者服用的不同药物,将其分为环孢素 A 组和他克莫司组。其中,环孢素 A 组 92 例患者服用环孢素 A;他克莫司组 18 例患者服用他克莫司。收集两组患者的年龄和性别等临床资料,观察比较肺移植受者及不同免疫抑制剂发生 CNI 相关肾损伤的情况,比较 MMF 前后环孢素 A 组和他克莫司组的 CNI 剂量。测量 MMF 给药前及给药后 30、60、90d 时血清肌酐水平和血清肌酐清除率的变化,观察肺移植后 CNI 相关肾损伤的并发症。实验结果显示,肺移植受者及不同免疫抑制剂中,CNI 相关肾损伤 16 例(14.55%),其中男 10 例(11.36%),女 6 例(27.27%),他克莫司组 11 例(12.09%),环孢素 A 组 5 例(26.32%)。两组比较差异无统计学意义(>0.05)。与 MMF 给药前后相比,环孢素 A 组和他克莫司组的 CNI 剂量明显减少(<0.01)。与 MMF 给药前相比,血清肌酐水平降低,血清肌酐清除率明显升高(<0.05)。随访发现,16 例 CNI 相关肾损伤患者在调整免疫抑制方案前均发生免疫排斥反应,调整免疫抑制方案后 15 个月内无免疫排斥、骨髓抑制、感染等并发症发生,术后 2 年内 3 例患者血糖升高,1 例患者血脂升高,1 例患者尿素升高,1 例患者尿酸升高。基于 CNI 减少的霉酚酸酯免疫抑制治疗是一种安全有效的免疫抑制治疗方法,可明显降低免疫排斥反应,改善肾功能,对改善肺移植后 CNI 相关肾损伤有重要作用。

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