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目的探讨肾移植术后三联免疫抑制剂应用的合适剂量。方法比较常规剂量组(145例)和低剂量组(128例)肾移植术后患者三联免疫抑制剂用量和急性排斥反应、肺部感染发生率和人/移植肾生存率。结果环孢素A(CsA)和吗替麦考酚酯(MMF)用量在术后6个月内常规剂量组明显高于低剂量组。常规剂量组在6个月内包括活检证实和临床推断,其总的急性排斥发生率为16.5%,而低剂量组为18.7%,两组间差异无统计学意义(P>0.05)。两组患者在6个月内肺部感染发生率分别为30.4%和10.2%(P<0.01),尤其是重症肺部感染发生率常规剂量组明显要高(22.1%比4.7%,P<0.01)。常规剂量组和低剂量组患者人/肾1年生存率分别为89.7%/86.9%和98.4%/96.9%(P<0.01)。排除感染所致的带功死亡后两组患者人/肾1年生存率差异无统计学意义。结论低剂量三联免疫抑制剂应用并不增加急性排斥率、亚临床排斥发生率、排斥治疗逆转率和排斥反应的严重程度,但明显降低肺部感染发生率和病死率。
Objective To investigate the appropriate dosage of triple immunosuppressant after renal transplantation. Methods The levels of triple immunosuppressant and acute rejection, the incidence of pulmonary infection and the survival rate of human / grafted kidney were compared between routine dose group (145 cases) and low dose group (128 cases) after renal transplantation. Results The dosage of cyclosporine A (CsA) and mycophenolate mofetil (MMF) in the 6-month postoperative routine dose group was significantly higher than that in the low dose group. The conventional dose group, including biopsy and clinical inference within 6 months, had a total acute rejection rate of 16.5% compared with 18.7% of the low dose group, with no significant difference between the two groups (P> 0.05). The incidence rates of pulmonary infection in both groups were 30.4% and 10.2% respectively within 6 months (P <0.01), especially those with severe pulmonary infection were significantly higher in the conventional dose group (22.1% vs 4.7%, P <0.01 ). The 1-year person / kidney 1-year survival rates were 89.7% / 86.9% and 98.4% / 96.9%, respectively (P <0.01) for the conventional and low-dose groups. There was no significant difference in 1-year survival rate between the two groups after exclusion of patients with infection. Conclusions The application of low dose triple immunosuppressant does not increase acute rejection rate, subclinical rejection rate, rejection rate and the severity of rejection but significantly reduce the incidence of pulmonary infection and mortality.