供体骨髓干细胞输注对肝移植术后早期恢复的疗效观察  

Clinical efficacy of donor stem cell infusion for liver transplant recipients in the early postoperative period

作　　者：张小进[1] 江艺[1] 吕立志[1] 杨芳[1] 蔡秋程[1] 林拥华[2] 

机构地区：[1]南京军区福州总医院肝胆病中心肝胆外科,福州350025 [2]南京军区福州总医院临床学院,福州350025

出　　处：《中华普通外科学文献（电子版）》2009年第5期34-37,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：南京军区医药卫生科研基金面上项目(08MA104)

摘　　要：目的探讨同期供体骨髓干细胞输注对肝脏移植受者术后早期康复的影响。方法以2008年3月至12月本中心的30例肝移植患者为研究对象,并进行随机分组。实验组8例,行同期供体骨髓干细胞联合肝脏移植;对照组22例,仅行同种异体肝移植,不行骨髓干细胞输注。观察两组患者术后肝功能恢复情况、急性排斥发生情况、感染并发症发生情况以及术后Α院时间和费⒚。结果实验组术后甲基强地松龙⒚量和出院时每日FK506用量低于对照组[甲基强地松龙用量:(1884±256)mgvs(1314±105)mg,P<0.01;FK506用量:(4.93±0.62)mg/dvs(3.73±0.35)mg/d,P<0.01];实验组术后3个月内急性排斥发生率显著低于对照组(0/8vs4/22,P<0.05),术后感染并发症发生率两组间无显著性差异;术后第1、3天实验组血清谷丙转氨酶、谷草转氨酶均显著低于对照组(P<0.05),术后第7天两组间无显著差异,而血清总胆红素、谷氨酰Κ肽酶、白蛋白等指标于术后第1、3、7天两组间对比均无显著差异;两组患者平均术后Α院时间、Α院费⒚无显著性差异。结论同期供体骨髓干细胞联合肝脏移植可以降低术后免疫抑制剂用量,减少急性排斥反应发生,一定程度上可减低早期肝脏再灌注损伤,不会增加患者的治疗风险、术后Α院时间和费⒚,是一种安全有效的治疗方法。Objective To evaluate the clinical efficacy of donor stem cell infusion in the patients following liver transplantation in the early postoperative period. Methods Thirty patients undergoing liver transplantation from Mar 2008 to Dec 2008 were randomly divided into control group （22 patients） and experimental group（8 patients）. Experimental group were performed donor stern cell infusion and liver transplantation, control group were only performed liver transplantation. Recovery of liver function, the incidence of acute rejection and infectious complications, postoperative hospital stay and costs were observed. Results experimental group patients showed a significantly lower total dose of methylprednisolone, daily dose of FK506 [methylprednisolone （1884 ± 256） mg vs （1314 ± 105） mg, P 〈0.01; FK506：（4.93 ±0.62） mg/d vs （3.73 ±0.35） rag/d, P 〈0.01]. It also showed a significantly lower incidence of acute rejection（O/8 vs 4/22, P 〈0.05）. Significantly lower level of serum alanine aminotransferase and aspartate aminotransferase on postoperative 1,3 day were found. There were no significant differences between the two groups in the incidence of infectious complications, serum transaminase on postoperative 7 day, serum total bilirubin, albumin and glutamyl transpeptidase enzyme on postoperative 1,3,7 day. No significant differences between the two groups in postoperative hospital length of stay and hospitalization costs. Conclusions Donor stem cell infusion can reduce the dosage of immunosuppressant, decrease incidence of acu terejection and reduce hepatic ischemia reperfusion injury for the liver transplant recipient. It is a safe and effective treatment measures for for the liver transplant recipient.

关 键 词：肝移植 干细胞 骨髓 免疫抑制剂 移植物排斥 

分 类 号：R657.3[医药卫生—外科学]