以FK506为基础的四联免疫抑制方案应用于肝移植的研究  

The application of FK506 based quadruple immunosuppression therapy in clinical liver transplantation

作　　者：卢安卫[1] 郑树森[1] 王卓轶[1] 陈海勇[1] 汤晓峰[1] 陈跃敏[1] 施邵华[1] 吴应盛[1] 庄莉[1] 

机构地区：[1]浙江大学医学院附属第一医院肝移植中心,杭州310003

出　　处：《中华普通外科杂志》2006年第6期403-404,418,共3页Chinese Journal of General Surgery

基　　金：国家重点基础研究发展计划(973计划)资助项目(2003CB515501)

摘　　要：目的探索以FK506为基础的四联免疫抑制方案在肝移植患者中的应用。方法2001年2月到2004年7月间40例成人尸体肝移植患者接受以FK506为基础的四联免疫抑制方案,比较高浓度(QH)组与低浓度(QL)组在术后6个月时的有效性与安全性。结果两组在急性排斥反应率、人/肝存活率、高血压、高血糖、感染的发生率差异均无统计学意义；QL组的手震颤发生率显著低于QH组(X^2=5．105,P=0．024),术后15 d、3个月血肌酐水平在QL组显著低于QH组(t_(15天)= 2．10,P_(15天)=0．042；t_(3月)=2．45,P_(3月)=0．019),术后3个月、6个月血胆固醇水平在QL组显著低于QH组(t_(3月)=2．35,P_(3月)=0．024；t_(6月)=2．11,P_(6月)=0．042)。结论QL组使用四联免疫抑制的安全性较好。用四联方案在术后6个月内FK506的血药浓度可控制在5～8 ng/ml。血胆固醇、血肌酐水平、手震颤的发生率与FK506的血药浓度呈正相关。Objective To evaluate FK506 based quadruple therapy protocol in clinical orthotopic liver transplantation. Methods From Feb 2001 to July 2004, 40 recipients were followed up for 6 months posttransplantation to compare the efficacy and safety between groups with high concentration of FKS06 （QH） and that of low level （QL）. Results The recipients and grafts survival rate at 6-month were not different between the two groups. On 6th month posttransplant, the incidence of acute rejection was 5% for QH group and 10% for QL group （χ^2 = 0.360, P = 0.548）; the occurrence of hypertension, hyperglycemia, and infection was not significantly different; the occurrence of hard tremor in QL group was less （χ^2 = 5. 105, P =0. 024）. Serum creatinine （Cr） was significantly lower in QL group than QH group on day 15 and the 3rd month postoperatively （ t15d = 2. 10, P15d =0. 042 ; t3M = 2. 45, P3M = 0. 019） ; The serum cholesterin was significantly lower in QL group than in QH group on the 3rd and 6th month postoperatively （t3M =2. 350,P3M =0. 024; t6M =2. 11, P6M =0. 042）. Conclusions Quadruple protocol with low blood concentration of FK506 did not increase the frequencies of acute rejection while reduced the toxicity significantly, in which, FK506 concentration could be safely controlled at 5 -8 ng/ml in the first 6 months postoperatively. The blood level of cholesterin and creatinine, and the occurrence of hard tremor were positively related to blood concentration of FK506.

关 键 词：肝移植 移植物排斥 免疫抑制剂 他克莫司 

分 类 号：R657.3[医药卫生—外科学]