冬虫夏草制剂在肾移植受者中的临床应用和机制探讨

作者	单位
丁晨光	西安交通大学医学院第一附属医院肾病中心肾移植科
田普训	西安交通大学医学院第一附属医院肾病中心肾移植科
靳占奎	西安交通大学医学院第一附属医院肾病中心肾移植科
李杨	西安交通大学医学院第一附属医院肾病中心肾移植科
燕航	西安交通大学医学院第一附属医院肾病中心肾移植科
项和立	西安交通大学医学院第一附属医院肾病中心肾移植科
丁小明	西安交通大学医学院第一附属医院肾病中心肾移植科
薛武军	西安交通大学医学院第一附属医院肾病中心肾移植科

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中文摘要:

目的回顾性研究和分析肾移植术后应用百令胶囊(冬虫夏草菌丝体干粉制剂)的免疫调节效果及对机体其他系统的影响,并探讨其可能的作用机制。方法67例同种异体肾移植术后受者入组,按免疫抑制剂的方案分为2组,对照组用霉酚酸酯(mycophenolate mofetil,MMF)加环孢素A(cyclosporine A,CsA)或他克莫司(tacrolimus,FK506)加泼尼松(prednisone,Pred)共42例;治疗组用MMF加CsA加百令胶囊或FK506加Pred加百令胶囊共25例。术后检测血、尿常规,肝、肾功能及尿酸等;分阶段记录免疫制剂使用量,随访48周。结果移植肾存活率、急慢性排斥反应发生率、肾功能恢复状况、两组比较差异无统计学意义;感染发生率治疗组显著低于对照组(P<0·05);治疗组尿中红、白细胞数量、血谷草转氨酶和谷丙转氨酶、血清尿酸、总胆红素、直接胆红素显著少于对照组(P<0·01),而血清总蛋白、白蛋白显著高于对照组(P<0·01);治疗组血红细胞、白细胞数量在肾移植术后12～48周显著高于对照组(P<0·05),淋巴细胞在肾移植术后4～48周显著高于对照组(P<0·01),并且恢复至正常值的时间较对照组提前。治疗组CsA和FK506的用量在术后12周之后显著低于对照组(P<0·05,P<0·01)。结论百令胶囊可以有效保护肾移植术后肝、肾,刺激造血,改善低蛋白血症,降低感染发生率,减少CsA、FK506的用量等,是一种较理想的免疫调节剂。

英文摘要:

Objective To retrospectively study and analyse the immune regulatory effect of Bailing Capsule (BLC,a dry powder preparation of Cordyceps sinensis mycelia) on patients after renal transplantation,its influences on various systems of organism,and to explore its possible acting mechanism.Methods In accordance with the entry criteria,67 recipients of renal homo-allograft were assigned to two groups.The 42 cases in the control group were treated with mycophenolate mofetil (MMF) plus cyclosporine A (CsA),or tacrolimus (FK506) plus prednisone (Pred);the 25 in the treated group treated with the chemotherapy the same as in the control group plus BLC.They were followed up for 48 weeks by checking up blood routine,urine routine,hepatic and renal function,total serum protein,serum albumin,uric acid,etc.,and the dosage of immunoinhibitors used was recorded periodically.Results Comparison showed no significant difference in graft survival rate,occurrence of reject reaction and renal function recovery between the two groups;but levels of urinary erythrocytes and leucocytes,blood alanine transaminase,aspartate amino transferase,uric acid,total bilirubin,direct bilirubin,as well as the incidence of infection were significantly lower,and serum total protein and albumin were significantly higher in the treated group (all P<0.01);moreover,counts of erythrocyte and leukocyte from 12 to 48 weeks,T-lymphocyte from 4 to 48 weeks after transplantation were significantly higher in the treated group (P<0.05 and P<0.01),and the recovery appeared earlier,the dosage of CsA or FK506 used 12 weeks after operation was significantly lower in the treated group than in the control group (P<0.05,P<0.01).Conclusions BLC could effectively protect liver and kidney,stimulate hemopoietic function,improve hypoproteinemia,as well as reduce the incidence of infection and the dosage of CsA and FK506 used,etc.Therefore,it is a useful drug for immunoregulation after organ transplantation.

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