中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (5): 803-806.doi: 10.3969/j.issn.1673-8225.2010.05.011

• 肝移植 liver transplantation • 上一篇    下一篇

肝移植患者应用无激素与早期激素撤停免疫抑制方案的评价

于  勇，罗祥基，易  滨，刘  辰，姜小清   

  1. 上海东方肝胆外科医院胆道一科，上海市  200438
  • 出版日期:2010-01-29 发布日期:2010-01-29
  • 通讯作者: 姜小清，教授，博士生导师，上海东方肝胆外科医院胆道一科，上海市 200438 jxq1225@sina. com
  • 作者简介:于 勇★，男，1982年生，山东省潍坊市人，汉族，2006解放军第二军医大学毕业，硕士，医师，主要从事肝胆外科、肝移植研究。 yluobosi@126.com 并列第一作者：罗祥基☆，男，1971年生，福建省龙岩市人，汉族，副教授，博士，上海东方肝胆外科医院胆道一科。

Evaluation of immunosuppressive schemes using non-steroid and early steroid withdrawal in patients following liver transplantation

Yu Yong, Luo Xiang-ji, Yi Bin, Liu Chen, Jiang Xiao-qing   

  1. First Department of Biliary Tract Diseases, Eastern Hepatobiliary Surgery Hospital, Shanghai  200438, China
  • Online:2010-01-29 Published:2010-01-29
  • Contact: Jiang Xiao-qing, Professor, Doctoral supervisor, First Department of Biliary Tract Diseases, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China jxq1225@sina.com
  • About author:Yu Yong★, Master, Physician, First Department of Biliary Tract Diseases, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China Luo Xiang-ji, Associate professor, Doctor, First Department of Biliary Tract Diseases, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China

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631

被引次数

5

摘要：

背景：国内外均出现了肾移植后联合应用单克隆抗体的早期激素撤停或半量激素应用方案，研究发现减少激素应用并未明显增加排斥反应的发生，但能否将单克隆抗体完全替代激素的方案安全有效地应用于肝移植患者，目前较少见报道。
目的：对肝移植患者应用无激素和早期激素撤停两种免疫抑制方案的观察，评价两种方案的临床疗效及安全性。
方法：肝癌肝移植患者80例，其中33例患者应用巴利昔单抗诱导的无激素免疫抑制方案(他克莫司+酶酚酸酯+巴利昔单抗)作为实验组；另47例患者应用早期激素撤停方案(他克莫司+酶酚酸酯+激素)作为对照组。对照组激素于移植后第1天以后逐日减量，至移植后1个月停用。随访观察两组患者排斥率、感染率、1年内肿瘤复发率及1年生存率。
结果与结论：实验组患者感染率、1年内肿瘤复发率明显低于对照组(P < 0.05)；两组患者排斥反应发生率及1年生存率差异无显著性意义(P > 0.05)。结果提示肝癌肝移植患者可以安全有效的应用无激素的巴利昔单抗免疫抑制方案，移植后感染率、肿瘤复发率明显低于激素治疗方案，并且不增加急性排斥反应的发生率。

关键词: 肝移植, 肿瘤复发, 巴利昔单抗, 激素, 免疫抑制剂

Abstract:

BACKGROUND: Recently emerged immunosuppressive scheme combined with basiliximab following liver transplantation, such as the early steroid withdrawal or half amount of steroid. Many studies demonstrated that it would not increase the rejection rate in reducing the use of steroid. However, there were rare reports addressing whether it was safe and effective to replace the steroid by basiliximab.
OBJECTIVE: Through the application of non-steroid and early steroid withdrawal immunosuppressive scheme in patients of hepatocellular carcinoma following liver transplantation, to evaluate the therapeutic effect and safety of two treatments.
METHODS: A total of 80 patients of hepatocellular carcinoma receiving liver transplantation were divided into the experimental and control group. In the experimental group, 33 patients were applied with non-steroid treatment (Tacrolimus+mycophenolate mofetil+basiliximab); additionally 47 patients were applied with early steroid withdrawal treatment (Tacrolimus+mycophenolate mofetil+ steroid). Steroid was reduced gradually from the first day after transplantation to discontinuation after 1 month. The rates of rejection, infection, cancer recurrence and 1-year survival were measured.
RESULTS AND CONCLUSION: Compared to the control group, the rates of infection and cancer recurrence were significantly smaller in the experimental group (P < 0.05). However, there was no significantly difference between 2 groups in the rates of rejection and 1-year survival (P > 0.05). It revealed that the non-steroid treatment can be safely and effectively applied in the patients with hepatocellular carcinoma following liver transplantation. The non-steroid treatment can significantly cut down the infection rate and cancer recurrence rate, which has no effect on the rejection and 1-year survival rate.

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