小肠移植术后免疫抑制治疗的随访与监测  

Follow-up and surveillance of immunosuppressive treatment in intestinal transplantation

作　　者：王凯[1] 李元新[1] 李宁 李幼生[1] 倪小冬[1] 王剑[1] 赵振国[1] 郭明晓[1] 黎介寿 

机构地区：[1]南京大学医学院临床学院解放军普通外科研究所,210002

出　　处：《中华器官移植杂志》2011年第5期281-285,共5页Chinese Journal of Organ Transplantation

摘　　要：目的通过对小肠移植免疫抑制治疗的有效性和安全性进行随访和监测，评估监测指标、方法和频率的合理性，总结治疗效果。方法对1994年3月至2009年11月间15例小肠移植受者的资料进行为期1年的回顾性分析，根据免疫抑制方案不同分为3个阶段（1994—1995年、2003—2006年和2007—2009年）。记录受者围手术期情况及术后1年内的生存状况，监测第3阶段受者术后1年内排斥反应、感染、药物不良反应的发生频率，观察受者淋巴细胞计数及比例、血他克莫司（Tac）浓度、肝功能、肾功能、血糖、血脂和血压等指标的变化，评价监测方法及频率的合理性。结果第1、2阶段移植肠存活未超过1年，第3阶段5例受者（移植物）6个月和1年的存活率分别为100％和83．33％。第3阶段术后7～12个月间受者共发生9次排斥反应，较术后1～6个月间（6次）有所增加。第3阶段造口还纳时间由过去的术后6个月调整至术后1年。此术后监测方法及频率检测出76．92％（10／13）的无症状轻度排斥反应。受者术后146个月淋巴细胞水平低下，感染风险较高。结论小肠移植术后1年内采用的监测方法、指标及频率是合理的，能够基本反映出受者的病情变化和监测重大事件。Objective To evaluate the efficiency of monitoring parameters and methods of immunosuppresive treatment in intestinal transplantation and to provide scientific evidence for establishment of Intestinal Transplant Registry. Methods The data of 15 patients receiving intestinal transplantation between 1994 and 2009 were analyzed retrospectively for one year. The patients were fallen into 3 eras （1994-1995, 2003-2006, 2007-2009） according to different immunosuppresive strategies. The perioperative status and one-year survival rate were followed up. The monitoring frequency of implications of intestinal transplantation, such as rejection, infection, toxic and sideeffects, was evaluated. The monitoring parameters were examined in the proportion of lymphocytes, concentration of tacrolimus, and function of the liver and kidney during a follow-up period of one year. Results During 1994-1995 and 2003-2006, the survival time of grafts was under one year. During 2007-2009, the 6-month and one-year survival rate in 5 patients （grafts） was 100% and 83. 33% respectively; The increased frequency of rejection occurred during 7 to 12 months after operation; The closure of abdominal stoma was postponed from postoperative six months to one year; Asymptomatic mild rejection after operation was examined （10/13, 76. 92% ）. Conclusion During one year postoperation, monitoring methods, parameters and frequency for immunosuppressive treatment in intestinal transplantation are rational, and may monitor the disease conditions of the patients.

关 键 词：小肠移植 免疫抑制法 随访 监测 

分 类 号：R656.7[医药卫生—外科学]