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目的 :探讨雷帕霉素 (rapamycin ,RPM)对肾移植受者血脂的影响。 方法 :收集 2 0 0 1年 3月至 2 0 0 2年 1 1月我院行首次尸体肾移植并开始接受RPM治疗随访至今的 2 3例受者 ,免疫抑制剂治疗方案为RPM联合环孢素 (CsA)和皮质类固醇三联疗法。移植后 4 8h内开始给予RPM治疗 ,首次负荷剂量为 6mg ,维持剂量为 2mg/d ,部分患者在血脂升高后RPM减量至 1～ 1 5mg/d ;定期检测RPM浓度、CsA浓度及各项血脂指标。 结果 :2 2例患者随访 6～ 1 2个月 ,1例因胃肠道不适中止随访。 1、3、6个月RPM平均浓度分别为 (5 1 2± 1 5 8)ng/ml、(6 83± 2 78)ng/ml、(6 1 1± 2 37)ng/ml;1 2个月内高脂血症发生率为 5 9% (1 3/ 2 2 ) ,RPM浓度与总胆固醇浓度相关系数r =0 383(P <0 0 0 1 ) ,与三酰甘油浓度相关系数r=0 2 8(P <0 0 1 ) ;术后血脂指标变化有一定规律 :胆固醇、HDL C、LDL C、载脂蛋白 (Apo)AI、ApoB的变化趋势相似 :术后第 7天基本与术前持平 ,术后 1个月明显上升 ,2～ 4个月达高峰 ,5～ 6个月开始回落 ,但仍高于术前水平 (P <0 0 5 ) ;三酰甘油呈缓慢上升趋势 ,术后 5～ 6个月达高峰 ,术后 1个月各时间点与术前比较差异均有显著性 (P <0 0 1 )。尽管本组患者血脂升高 ,但随访至今移植物血管
Objective: To investigate the effect of rapamycin (RPM) on blood lipids in renal transplant recipients. Methods: From March 2001 to January 2001, the first cadaveric kidney transplant from March 2001 to January 2002 in our hospital was started and 23 patients were followed up until now. The immunosuppressive therapy regimen was RPM combined with cyclosporine (CsA) and corticosteroid triple therapy. RPM was started within 48 h after transplantation. The initial loading dose was 6 mg and the maintenance dose was 2 mg / d. In some patients, the RPM was reduced to 1-55 mg / d after the elevated lipids. The RPM, CsA and Item lipids. Results: Twenty-two patients were followed up for 6 to 12 months. One patient was discontinued due to gastrointestinal discomfort. The average RPM of 1,3,6 months were (51 2 ± 1 58) ng / ml, (6 83 ± 2 78) ng / ml and (61 1 ± 2 37) ng / ml, respectively The incidence of hyperlipidemia was 59% (1 3/2 2) in a month, r = 0 383 (r = 0 0 01), and the correlation coefficient between r and concentration of triglyceride r = 0 2 8 (P 0 01). There was a certain regularity of postoperative blood lipid changes: the trends of cholesterol, HDL C, LDL C, Apo AI and ApoB were similar: Preoperative flat, 1 month after surgery increased significantly, reached a peak 2 to 4 months, 5 to 6 months began to fall, but still higher than preoperative levels (P <0 05); triglyceride was slowly rising trend , Peaked at 5-6 months postoperatively, and there was significant difference between preoperative and postoperative 1 month (P <0.01). Although this group of patients with elevated blood lipids, but up to now graft blood vessels