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目的探讨使用环孢素A(CsA)的肾移植患者合用地尔硫芯卓的临床效果。方法将1529例肾移植患者分为研究组和对照组,研究组肾移植术后应用CsA、硫唑嘌呤(Aza)及泼尼松(Pred)(研究组1)或CsA、霉酚酸酯(MMF)及Pred(研究组2)预防排斥反应,两个研究组同时加用地尔硫芯卓;对照组使用CsA、Aza及Pred预防排斥反应,不用地尔硫芯卓。观察研究组和对照组的CsA用量、血CsA浓度、移植效果、急性排斥反应发生率以及CsA的肝、肾毒性。结果研究组1的CsA用量低于对照组(P<0.05),但血CsA浓度明显高于对照组(P<0.01);研究组2的CsA用量显著低于对照组(P<0.01),但血CsA浓度与对照组相近(P>0.05);研究组1和研究组2移植肾功能恢复正常的时间分别缩短至4.7d和3.9d,较对照组显著提前(P<0.05);两个研究组的急性排斥反应发生率较对照组明显降低(P<0.05,P<0.01)。结论应用CsA的肾移植患者合用地尔硫芯卓,能明显提高血CsA浓度,从而减少CsA用量,同时能促进移植肾功能的恢复,改善移植效果。
Objective To investigate the clinical effect of diltiazem combined with CsA on renal transplant recipients. Methods 1529 renal transplant recipients were divided into study group and control group. CsA, Aza and prednisone (Study Group 1) or CsA, mycophenolate mofetil (CsA) MMF), and Pred (study group 2). Diltiazem was added to both study groups. CsA, Aza, and Pred were used in the control group to prevent rejection without diltiazem. The dose of CsA, blood CsA concentration, transplantation effect, incidence of acute rejection and liver and kidney toxicity of CsA were observed in study group and control group. Results The CsA concentration in study group 1 was lower than that in control group (P <0.05), but the concentration of CsA in serum was significantly higher than that in control group (P <0.01). The CsA dosage in study group 2 was significantly lower than that in control group (P <0.01) The concentration of CsA in blood was similar to that in the control group (P> 0.05). The normal time of renal function recovery in study group 1 and study group 2 was shortened to 4.7 days and 3.9 days, respectively, which was significantly earlier than the control group (P <0.05) The incidence of acute rejection in the group was significantly lower than that in the control group (P <0.05, P <0.01). Conclusion The combination of diltiazem and cilostazol in renal transplantation patients with CsA can significantly increase the concentration of blood CsA, thereby reducing the dosage of CsA, and at the same time, it can promote the recovery of renal graft function and improve the transplantation effect.