论文部分内容阅读
本综述总结西罗莫司用于预防肾移植术后排斥反应的各种用药方案,从急性排斥发生率、肾功能、人/肾存活率4个方面综合比较各种用药方案同其他传统免疫抑制方案的优劣。综合比较显示,肾移植术后转换使用西罗莫司是最值得推荐的用药方案。在环孢素与西罗莫司联用(CsA+SRL)过程中减、停环孢素也是可以考虑的方案,但要注意控制西罗莫司浓度。西罗莫司可以替换麦考酚酸酯,此时钙调神经蛋白抑制剂(CNI)应适当减量。起始低剂量西罗莫司与CNI联用(CNI+SRL),以及起始足量CNI+SRL并维持、起始不含CNI以及术后移植肾功能延迟恢复(DGF)过渡期使用西罗莫司均应当避免。西罗莫司支持术后撤停激素,此种情况下推荐西罗莫司与他克莫司联用。需定期监测西罗莫司谷浓度,并多数情形下推荐使用首剂负荷剂量。
This review summarizes the various regimens of sirolimus for the prevention of rejection after renal transplantation, and compares the various drug regimens with other traditional immunosuppressive measures in terms of the incidence of acute rejection, renal function and the survival rate of human / kidney The pros and cons of the program. Comprehensive comparison shows that the conversion of sirolimus after renal transplantation is the most recommended drug regimen. Cyclosporine is also an acceptable regimen during cyclosporine plus sirolimus (CsA + SRL), but care should be taken to control the concentration of sirolimus. Sirolimus can replace mycophenolate mofetil, when calcineurin inhibitors (CNI) should be appropriately reduced. Initial low-dose sirolimus in combination with CNI (CNI + SRL) and initial CNI + SRL start-up and maintenance, CNI-free and postoperative delayed graft transplant (DGF) Moose should be avoided. Sirolimus support withdrawal hormone after surgery, in this case recommended sirolimus combined with tacrolimus. Regular monitoring of the concentration of sirolimus is required and in most cases the first dose loading is recommended.