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低剂量多巴胺对移植肾脏的影响  

2009-01-26 20:46:19|  分类: 移植研究 |  标签: |举报 |字号 订阅

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尽管多巴胺对移植肾脏的作用仍有争议,在一些中心仍被应用为具有肾脏保护功能的常规药物。对正常肾脏,低剂量多巴胺可以改善血流、降低阻力指数并有一定的利尿作用。本研究假设多巴胺对缺乏神经支配的移植肾脏难以发挥类似的作用。在一组对照研究中,以多普勒彩超分析低剂量多巴胺对移植肾脏血流速度和血流阻力的影响。结果显示发生延迟恢复的肾脏动脉流速低于功能恢复正常的移植肾脏,多普勒彩超显示低剂量的多巴胺对移植肾脏血流速度和血流阻力指数均无显著影响,倒是环孢素A的谷浓度值于平均血流阻力指数值相关。手术本身和冷热缺血时间并不能解释低剂量多巴胺功效的丧失。因此,移植后的肾脏短期内对多巴胺不敏感,而其他因素如环孢素A的血管收缩作用会对移植肾脏的血流产生影响,移植后的低剂量多巴胺可能是无效的。

原文出处:

 Clin Transplant. 1999 Dec;13(6):479-83.

 Low-dose dopamine after kidney transplantation: assessment by Doppler ultrasound.

Spicer ST, Gruenewald S, O'Connell PJ, Chapman JR, Nankivell BJ.

Low-dose dopamine (LDD) is commonly used after kidney transplantation as a renoprotective agent, although the benefits of dopamine (DA) in this setting are controversial. LDD increases renal blood flow, decreases resistive index (RI) and causes diuresis in normal kidneys. We hypothesised that the vasculature of a denervated renal transplant may not respond to DA in the same way as healthy native kidneys. In a prospective, controlled study, renal blood flow velocity and vascular resistance were measured by Doppler ultrasound in recent kidney transplants (n = 20) over a range of DA doses (0-5 microg/kg/min). Main renal artery velocity was lower in kidneys with acute renal dysfunction than in those with normal function (0.60 +/- 0.31 vs. 0.81 +/- 0.24, respectively, p < 0.05). There was no demonstrable haemodynamic effect of LDD on either RI or main renal artery velocity as measured by Doppler ultrasound. Interestingly, the only significant correlation with mean RI was trough cyclosporin A level (r = 0.57, p < 0.001). Technical or timing factors cannot be used to explain the absence of DA effect, with equivalent doses capable of producing vasodilatation and reduced RI in studies of normal kidneys. In summary, these findings contrast the DA response of healthy native kidneys and may explain studies showing no clinical benefit of LDD in the early post-transplant period. These data suggest an insensitivity of recently implanted kidneys to the vasodilatory effects of LDD, that other factors such as cyclosporin A vasoconstriction may also be important, and question the rationale for routine LDD after kidney transplantation.

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