含西罗莫司的四联免疫抑制剂方案对肾移植术后患者肾功能、T淋巴细胞亚群及预后的影响

doi:10.3760/cma.j.issn.1007-1245.2022.06.004

国际医药卫生导报 ›› 2022, Vol. 28 ›› Issue (6): 752-755.DOI: 10.3760/cma.j.issn.1007-1245.2022.06.004

含西罗莫司的四联免疫抑制剂方案对肾移植术后患者肾功能、T淋巴细胞亚群及预后的影响

索敬钧杨青彦李涛韩健乐杨俊伟王长安杨帅平

郑州市第七人民医院肾移植肾脏病诊疗中心，郑州　450000

收稿日期:2021-07-26 出版日期:2022-03-15 发布日期:2022-04-15
通讯作者: 索敬钧，Email：pnnpbz@163.com
基金资助:
2019年河南省医学科技攻关计划项目（LHGJ20191121）

Effects of sirolimus-containing quadruple immunosuppressor on renal function, T lymphocyte subsets, and prognosis in patients after renal transplantation

Suo Jingjun, Yang Qingyan, Li Tao, Han Jianle, Yang Junwei, Wang Changan, Yang Shuaiping

Center of Kidney Transplant and Nephropathy Treatment, Zhengzhou Seventh People's Hospital, Zhengzhou 450000, China

Received:2021-07-26 Online:2022-03-15 Published:2022-04-15
Contact: Suo Jingjun, Email: pnnpbz@163.com
Supported by:
Medical Science and Technology Key Project of Henan Province in 2019 (LHGJ20191121)

摘要/Abstract

摘要： 目的　探究含西罗莫司的四联免疫抑制剂方案对肾移植术后患者肾功能、T淋巴细胞亚群及预后的影响。方法　选取2017年1月至2021年1月在郑州市第七人民医院接受肾移植手术患者115例为研究对象，根据药物治疗方案分为A组（66例）和B组（49例）。A组男29例、女37例，年龄（47.6±14.3）岁，采用三联免疫抑制治疗；B组男23例、女26例，年龄（45.2±14.7）岁，在三联免疫基础上加含西罗莫司的四联方案联合治疗。比较两组患者术前和术后6个月的肾功能指标［血肌酐（Scr）、血β2-微球蛋白（β2-MG）、胱抑素C（CysC）］、免疫功能T淋巴细胞亚群以及术后急性排斥反应、移植肾丢失、肺部感染及死亡等情况。计量资料采用独立样本t检验，计数资料采用χ²检验。结果　治疗前，两组肾移植手术患者Scr、β2-MG、CysC水平比较，差异均无统计学意义（均P>0.05）；治疗后，B组患者Scr、β2-MG、CysC水平分别为（104.39±30.91）μmol/L、（2.94±1.71）mg/L、（0.79±0.15）mg/L，均低于A组（128.54±37.21）μmol/L、（3.57±1.29）mg/L、（0.86±0.12）mg/L，差异均有统计学意义（均P<0.05）。治疗前，两组肾移植手术患者CD3⁺、CD8⁺及CD4⁺/CD8⁺水平比较，差异均无统计学意义（均P>0.05）；两组肾移植手术患者CD4⁺水平治疗前后比较，差异均无统计学意义（均P>0.05）；治疗后，B组患者CD3⁺、CD8⁺及CD4⁺/CD8⁺水平分别为（60.90±10.15）%、（20.06±6.69）%、（1.21±0.14），均低于A组（65.29±10.58）%、（22.65±6.94）%、（1.27±0.17），差异均有统计学意义（均P<0.05）。两组肾移植手术患者术后6个月不良反应发生率比较，差异无统计学意义（P>0.05）。结论　肾移植术后给予含西罗莫司的四联免疫抑制剂方案，调节免疫功能更佳，且不会加重肾功能损伤。

关键词: 肾移植, 西罗莫司, 免疫抑制剂, 肾功能, 免疫功能

Abstract: Objective　To explore the effects of sirolimus-containing quadruple immunosuppressor on renal function, T lymphocyte subsets, and prognosis in patients after renal transplantation. Methods　A total of 115 patients undergoing renal transplantation in Zhengzhou Seventh People's Hospital were enrolled as the research objects between January 2017 and January 2021. According to different treatment regimens, they were divided into group A [29 males and 37 females, aged (47.6±14.3) years] and group B [23 males and 26 females, aged (45.2±14.7) years]. Group A was treated with triple immunosuppressor, and group B was treated with sirolimus-containing quadruple immunosuppressor on the basis of group A. The renal function indexes [serum creatinine (Scr), β2-microglobulin (β2-MG), and cystatin C (CysC)] and T lymphocyte subsets before and 6 months after surgery, and occurrence of postoperative acute rejection, transplanted kidney loss, lung infection, and death were compared between the two groups. Independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　Before treatment, there were no statistically significant differences in the levels of Scr, β2-MG, and CysC between the two groups (all P>0.05); after treatment, the levels of Scr, β2-MG, and CysC in group B were (104.39±30.91) μmol/L, (2.94±1.71) mg/L, and (0.79±0.15) mg/L, respectively, which were lower than those in group A [(128.54±37.21) μmol/L, (3.57±1.29) mg/L, and (0.86±0.12) mg/L], with statistically significant differences (all P<0.05). Before treatment, there were no statistically significant differences in the levels of CD3⁺, CD8⁺, and CD4⁺/CD8⁺ between the two groups (all P>0.05); there was no statistically significant difference in the CD4⁺ level between the two groups before and after treatment (both P>0.05); after treatment, the levels of CD3⁺, CD8⁺, and CD4⁺/CD8⁺ in group B were (60.90±10.15)%, (20.06±6.69)%, and (1.21±0.14), respectively, which were lower than those in group A [(65.29±10.58)%, (22.65±6.94)%, and (1.27±0.17)], with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions within 6 months after renal transplantation between the two groups (P>0.05). Conclusion　The application of sirolimus-containing quadruple immunosuppressor after renal transplantation can better regulate immune function, without aggravating renal function injury.

Key words: Renal transplantation, Sirolimus, Immunosuppressor, Renal function, Immune function

索敬钧, 杨青彦, 李涛, 韩健乐, 杨俊伟, 王长安, 杨帅平. 含西罗莫司的四联免疫抑制剂方案对肾移植术后患者肾功能、T淋巴细胞亚群及预后的影响[J]. 国际医药卫生导报, 2022, 28(6): 752-755.

Suo Jingjun, Yang Qingyan, Li Tao, Han Jianle, Yang Junwei, Wang Changan, Yang Shuaiping. Effects of sirolimus-containing quadruple immunosuppressor on renal function, T lymphocyte subsets, and prognosis in patients after renal transplantation[J]. International Medicine and Health Guidance News, 2022, 28(6): 752-755.

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含西罗莫司的四联免疫抑制剂方案对肾移植术后患者肾功能、T淋巴细胞亚群及预后的影响

Effects of sirolimus-containing quadruple immunosuppressor on renal function, T lymphocyte subsets, and prognosis in patients after renal transplantation

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