肝移植后应用巴利昔单抗同时撤减激素的免疫抑制治疗方案  

Administration of basiliximab for immunusuppressive therapy after liver transplantation with withdrawal of steroids

作　　者：蒋文涛[1] 朱志军[1] 蔡金贞[1] 张雅敏[1] 高伟[1] 张建军[1] 沈中阳[1] 

机构地区：[1]天津市第一中心医院,300192

出　　处：《中华器官移植杂志》2008年第1期25-27,共3页Chinese Journal of Organ Transplantation

摘　　要：目的探讨肝移植后加用巴利昔单抗的情况下采用撤减激素的免疫抑制方案的临床效果。方法首次肝移植患者60例，术后采用他克莫司和霉酚酸酯预防排斥反应，并分别于术中和术后第4天各给予1剂巴利昔单抗，其中20例不用激素，40例仅术中开放血流前使用甲泼尼龙1次，术后不再使用激素，此60例为撤减激素组。以同期完成的、术后采用含甲泼尼龙的免疫抑制方案的60例肝移植患者为对照组。观察两组患者及移植物的存活情况以及急性排斥反应、巨细胞病毒磷蛋白（CMV pp65）阳性及术后新发糖尿病的发生情况。结果术后随访12个月，不用激素者、单次使用激素者及对照组的患者存活率分别为95．0％、92．5％和91．7％，移植肝存活率分别为95％、90％和90％，急性排斥反应发生率分别为10．0％、12．5％及11．7％，三者间两两比较，患者存活率、移植肝存活率和急性排斥反应发生率的差异均无统计学意义。不用激素者、单次使用激素者及对照组的CMV pp65阳性率分别为15．0％、20．0％和43．3％，新发糖尿病发生率分别为5．0％、7．5％和30．0％，撤减激素组明显低于对照组（P〈0．05）。结论肝移植后，在加用巴利昔单抗的情况下采用撤减激素的免疫抑制方案，并不增加排斥反应的发生率，并能降低CMV pp65阳性率和新发糖尿病发生率。Objective To assess the clinical effect of Basiliximab administration for immunosup- pressive therapy after liver transplantation with withdrawal of steroids. Methods Sixty patients undergoing first liver transplantation were postoperatively administered with tacrolimus and mycophenolate mofetil to prevent rejection, received Basiliximab. one dose intravenously during operation and one dose on the postoperative day 4. Among them, 20 were not subjected to any steroid, and 40 were administered with one dose steroid only before graft reperfusion intraoperatively, and then not subjected to any steroid post-operation. These 60 recipients served with steroid withdraw group. The outcomes were compared with those of 60 patients who received liver transplantation at the same period, and administered with steroid immunosuppressive regimen. The postoperative recipient and graft survival, acute rejection, cytomegalovirus （CMV） antigenemia and postoperative new-onset diabetes between the two groups were also compared. Results During a follow-up of 12 months post-operation, the recipient survival rate of patients without using any steroid, subject to one dose steroid and control group was 95. 0% and 92. 5% and 91.7% separately, the graft survival time was 95%, 90% and 90%, and the incidence of acute rejection was 10. 0%, 12. 5% and 11.7% respectively, with difference being not significant among 3 groups. The cytomegalovirus （CMV） antigenemia rate of patients without using any steroid, subject to one dose steroid and control group was 15. 0%, 20. 0% and 43.3%, and the occurrence of postoperative new-onset diabetes was 5. 0%, 7. 5% and 30. 0% respectively, significantly lower in steroid withdraw group than control group （P〈0. 05）. Conclusion After liver transplantation, Basiliximab administration for immunosuppressive therapy with withdrawal of steroids does not increase the incidence of acute rejection, moreover decrease CMV antigenemia rate and postoperative new-onset diabetes rate.

关 键 词：免疫抑制法 肝移植 糖皮质激素 受体 白细胞介素2 抗体 单克隆 

分 类 号：R657.3[医药卫生—外科学]