两剂激素联合两剂达利珠单抗及他克莫司的免疫抑制方案在肝移植中的应用  

Two-dose steroid combined with two-dose daclizumab and tacrolimus regimen in liver transplant recipients

作　　者：鞠卫强[1] 何晓顺[1] 谈雅莉[1] 巫林伟[1] 邰强[1] 胡安斌[1] 王东平[1] 马毅[1] 朱晓峰[1] 黄洁夫[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中华外科杂志》2009年第14期1064-1066,共3页Chinese Journal of Surgery

基　　金：China Medical Boardin New York资助项目（06837）;广东省自然科学基金资助项目（06104600）

摘　　要：目的探讨两剂激素联合两剂达利珠单抗及他克莫司（FK506）的免疫抑制方案在肝移植中应用的安全性及有效性。方法中山大学附属第一医院器官移植中心2006年9月至2008年3月共实施成人肝移植74例，排除3例血型不合、4例围手术期死亡外，余67例纳入本研究，其中男性54例，女性13例，年龄28～66岁，平均（46．9±8．7）岁。将67例成人肝移植患者随机分为两组：传统免疫抑制方案（激素3个月撤离）组（n=35）和两剂激素免疫抑制方案组（n=32），比较两组术后代谢并发症、感染（含细菌、真菌及巨细胞病毒感染）及排斥反应的发生率的差异。结果两组患者的术后早期高血糖发生率，高血糖患者使用胰岛素的平均剂量，随访期内糖尿病、高血压及感染的发生率的差异有统计学意义（P〈0．05）；术后早期高血压发生率及随访期内排斥反应的发生率和高脂血症发生率无明显差异（P〉0．05）。结论两剂激素的免疫抑制方案是安全有效的，其不增加急性排斥反应的发生率，并可显著减少长期使用激素引起的各种不良反应及并发症的发生。Objective To investigate the efficiency and safty of two-dose steroid combined with twodose daclizumab and taerolimus （FK506） regimen in liver transplant recipients. Methods There were 74 patients who treated in the First Affiliated Hospital of Sun Yat-Sen University from September 2006 to March 2008. Expect for 7 patients who didn＇t measure up, 67 adult liver transplant recipients were randomized into two groups ： conventional protocol group （ n = 35 ） in which steroid was withdrawn in 3 months after operation, and two-dose steroid group （n = 32 ） . Comparison of rejection, infection （bacteria, fungal and cytomegalovirus） and metabolic complications rates were studied between two groups. Results There were significant differences between two groups in the rate of early postoperation hyperglycemia, the average dosage of insulin consumption among hyperglycemia recipients as well as the rate of diabetes mellitus, hypertension and infection during the follow-up period（ P 〈 0. 05 ）. The rate of hypertension in early postoperation period, hyperlipemia and rejection rate during the follow-up period were similar in two groups （ P 〉 0. 05 ）. Conclusions Two-dose steroid combined with two-dose daclizumab and tacrolimus would be a safe and efficient immunosuppression strategy without increase the acute rejection rate hazard, that could reduce posttransplant infection and other complications from side-effect of long-term usage of steroid.

关 键 词：肝移植 免疫抑制剂 达利珠单抗 他克莫司 

分 类 号：R686[医药卫生—骨科学]