Carrier M, Pelletier G B, White M, Bois D, Pelletier L C
Montreal Heart Institute, Quebec, Canada.
J Heart Lung Transplant. 1996 Dec;15(12):1179-83.
Pentoxifylline was suggested to prevent the renal release of endothelin caused by cyclosporine.
We studied the renal-sparing effect of pentoxifylline in 44 patients who underwent heart transplantation between 1991 and 1994 and were randomized to a group treated with pentoxifylline (400 mg three times daily) or to a control group. All patients were treated according to the same immunosuppression protocol, including induction with perioperative rabbit anti-thymocyte antibody and maintenance with azathioprine, cyclosporine, and prednisone. Five patients withdrew voluntarily because of lack of compliance, and five patients died during the first month of the study.
There was no difference between the two groups in regard to age, sex, initial cardiopathy, the number of acute rejections, and the number of infection episodes. Urinary clearance of creatinine averaged 1.1 +/- 0.1 ml/sec, 1.3 +/- 0.1 ml/sec, and 1.3 +/- 0.1 ml/sec in the control patients (n = 16) and 1.2 +/- 0.1 ml/sec, 1.4 +/- 0.1 ml/sec, and 1.3 ml/sec in patients treated with pentoxifylline (n = 18) at initiation, 12 months, and 24 months of the study (p > 0.05), respectively. At these three times, the serum creatinine levels averaged 106 +/- 4 mmol/L, 119 +/- 4 mmol/L, and 126 +/- 5 mmol/L in the control group and 94 +/- 4 mmol/L, 114 +/- 4 mmol/L, and 127 +/- 5 mmol/L in patients treated with pentoxifylline, respectively (p > 0.05). Trough levels of cyclosporine throughout the study period averaged 212 +/- 8 mmol/L and 206 +/- 8 mmol/L in the control and treated groups, respectively (p > 0.05). Endothelin blood levels averaged 0.4 +/- 0.2 pg/ml for nine control patients and 0.4 +/- 0.1 pg/ml for a group of 10 patients treated with pentoxifylline (p > 0.05).
Pentoxifylline in association with cyclosporine did not result in a significant improvement in renal function during the first 2 years after heart transplantation.
已有人提出己酮可可碱可预防环孢素引起的肾内皮素释放。
我们研究了己酮可可碱对44例在1991年至1994年间接受心脏移植患者的肾脏保护作用，这些患者被随机分为接受己酮可可碱治疗组（每日3次，每次400毫克）和对照组。所有患者均按照相同的免疫抑制方案进行治疗，包括围手术期使用兔抗胸腺细胞抗体诱导治疗以及使用硫唑嘌呤、环孢素和泼尼松维持治疗。5例患者因依从性差而自愿退出，5例患者在研究的第一个月内死亡。
两组在年龄、性别、初始心脏病情况、急性排斥反应次数和感染发作次数方面无差异。在研究开始时、12个月和24个月时，对照组（n = 16）患者的肌酐尿清除率平均分别为1.1±0.1毫升/秒、1.3±0.1毫升/秒和1.3±0.1毫升/秒，己酮可可碱治疗组（n = 18）患者的肌酐尿清除率平均分别为1.2±0.1毫升/秒、1.4±0.1毫升/秒和1.3毫升/秒（p>0.05）。在这三个时间点，对照组血清肌酐水平平均分别为106±4毫摩尔/升、119±4毫摩尔/升和126±5毫摩尔/升，己酮可可碱治疗组患者的血清肌酐水平分别为94±4毫摩尔/升、114±4毫摩尔/升和127±5毫摩尔/升（p>0.05）。在整个研究期间，对照组和治疗组环孢素的谷值水平平均分别为212±8毫摩尔/升和206±8毫摩尔/升（p>0.05）。9例对照组患者的内皮素血水平平均为0.4±0.2皮克/毫升，10例己酮可可碱治疗组患者的内皮素血水平平均为0.4±0.1皮克/毫升（p>0.05）。
心脏移植后的头两年内，己酮可可碱与环孢素联合使用并未使肾功能得到显著改善。
