Glucocorticosteroids in Renal Transplantation
Glucocorticosteroids in Renal Transplantation
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糖皮质激素在肾移植中的应用
DOI：
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发表时间：
1982
影响因子：
3.7
通讯作者：
B. Eklund
中科院分区：
文献类型：
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作者：
P. Häyry;E. Willebrand;J. Ahonen;B. Eklund
我们试图定义一种更“经济”的方法，通过将大多数糖皮质激素（GS）转移到手术后立即给药。30例尸体肾受者随机分为两组，每组15例，采用移植吸吸细胞学（TAC）监测。移植后，高剂量实验组接受3.5 mg/kg/天的甲基泼尼松龙（MP）治疗，14天后逐渐减少到0.4 mg/kg/天，低剂量对照组1.0 mg/kg/天，5天后逐渐减少到0.4 mg/kg/天。在发生排斥反应后，高剂量实验组患者接受最多7 mg/kg/天的口服MP治疗，分为每天4次，而低剂量对照组患者接受1-3次静脉注射，剂量为14 mg/kg（约1000 mg/70 kg）。移植后30天内，实验组出现7次临床表现排斥反应，2次原位炎症（无排斥反应迹象），对照组出现18次临床表现排斥反应，6次炎症反应。实验组患者首次炎症发作时间由对照组的5.0±1.5天延迟至6.6±1.0天（P=0.00），首次临床排斥反应时间由对照组的5.4±2.1天延迟至8.5±1.0天（P=0.00）。TAC分析显示，实验组炎症的首次发作明显少于对照组（P=0.001），尽管T淋巴细胞和单核细胞的频率与对照组相似（P= 1.00和0.20），但原位B淋巴细胞和淋巴细胞的频率中度抑制（P=0.04和0.04），巨噬细胞的积聚既抑制（P=0.07）又延迟。初始高剂量MP后，排异反应更短，更容易克服：第一次炎症发作的持续时间从对照组的10.5±4.4天减少到实验组的5.9±4.0天（P=0.02），临床排斥反应的持续时间从8.4±4.1天减少到3.9±3.4天（P=0.01）。经过18个月的随访研究，实验组中有12例患者接受了维持生命的移植物，而对照组中只有7例。两组之间并发症的发生频率和类型没有差异。
We have made an attempt to define a more ‘economical’ method for glucocorticosteroid (GS) administration in renal transplantation in man by shifting most of the GS to the immediate post‐operative period. Thirty cadaver kidney recipients were prerandomized in 2 groups of 15 patients and monitored by transplant aspiration cytology (TAC). After transplantation the high‐dose experimental group received 3.5 mg/kg/day of methyl‐predinisolone (MP), tapered to 0.4 mg/kg/day in 14 days, and the low‐dose control group 1.0 mg/kg/day, tapered to 0.4 mg/kg/day in 5 days. Upon rejection the patients in the high‐dose experimental group were treated with at most 7 mg/kg/day of oral MP divided into four doses daily, whereas the low‐dose control group received 1–3 intravenous boluses of 14 mg/kg (approximately 1000 mg/70 kg). Within 30 days after the transplantation, 7 clinically manifest rejection episodes and 2 episodes of in situ inflammation (without signs of rejection) were recorded in the experimental group, compared with 18 clinically manifest rejection episodes and 6 episodes of inflammation in the control group. The onset of the first episode of inflammation was delayed from 5.0±1.5 days in the control group to 6.6 ± 1.0 days (P=0.00) in the experimental group, and the onset of the first clinical rejection from 5.4±2.1 days to 8.5±1.0 days (P=0.00), respectively. TAC analysis documented that the first episode of inflammation was significantly smaller in the experimental group than in the control group (P=0.001), although the frequency of T lymphoblasts and monocytes was similar to that in the control group (P= 1.00 and 0.20), the frequency of in situ B lymphoblasts and lymphocytes was moderately depressed (P=0.04 and 0.04), and the accumulation of macrophages was both depressed (P=0.07) and delayed. After high initial MP administration the rejections were shorter and easier to overcome: the duration of the first inflammation episode was reduced from 10.5±4.4 days in the control group to 5.9±4.0 days (P=0.02) in the experimental group and the duration of clinical rejection from 8.4±4.1 days to 3.9±3.4 days, respectively (P=0.01). After 18‐month follow‐up study 12 patients in the experimental group had a life‐supporting graft, compared with 7 patients in the control group. There was no difference in the frequency or type of complications between the two groups.