肝移植术后应用巴利昔单克隆抗体诱导的无糖皮质类固醇激素免疫抑制治疗方案的临床疗效  

Clinical efficacy of basiliximab-induced glucose-free corticosteroid immunosuppressive regimen after liver transplantation

作　　者：张冬华[1] 陈榕 王轩[1] 张荣生[1] 张斌[1] 李增才[1] 江涛[1] 陆雷[1] 王兵济[1] Zhang Donghua;Chen Rong;Wang Xuan;Zhang Rongsheng;Zhang Bin;Li Zengcai;Jiang Tao;Lu Lei;Wang Bingji(Liver Transplantation Center,Bayi Hospital Affiliated to Nanjing University of Traditional Chinese Medicine,Nanjing 210002,China)

机构地区：[1]南京中医药大学附属八一医院肝移植中心,210002

出　　处：《中华消化外科杂志》2018年第10期997-1001,共5页Chinese Journal of Digestive Surgery

基　　金：南京军区医学科技创新重点资助项目（12Z15）

摘　　要：目的：探讨肝移植术后应用巴利昔单克隆抗体诱导的无糖皮质类固醇激素免疫抑制治疗方案的临床疗效。方法：采用回顾性队列研究方法。收集2010年1月至2016年10月南京中医药大学附属八一医院收治的227例行肝移植患者的临床病理资料。227例患者中，125例术后采用巴利昔单克隆抗 体＋他克莫司＋吗替麦考酚酯片的无糖皮质类固醇激素免疫抑制治疗方案，设为无激素组；102例术后常规采用糖皮质类固醇激素＋他克莫司＋吗替麦考酚酯片免疫抑制治疗方案，设为激素组。观察指标：（1）随访和生存情况比较。（2）两组患者术后感染、排斥反应、胆道狭窄发生情况比较。采用门诊和电话方式进行随访，了解患者术后生存情况及感染、排斥反应、胆道狭窄发生情况。随访时间截至2017年6月。正态分布的计量资料以±s表示，组间比较采用t检验。偏态分布的计量资料以M（P25，P75）和M（范围）表示，组间比较采用秩和检验。计数资料比较采用χ^2检验。采用Kaplan-Meier法绘制生存曲线和计算生存率，采用Log-rank检验进行生存分析。结果：（1）随访和生存情况比较：两组患者均获得术后随访，随访时间为9～89个月，中位随访时间为45个月。无激素组患者术后1、3年总体生存率分别为93.25%、85.24%，激素组患者分别为89.89%、74.22%，两组患者术后总体生存情况比较，差异有统计学意义（χ^2=8.450，P〈0.05）。（2）两组患者术后感染、排斥反应、胆道狭窄发生情况比较：①无激素组和激素组患者术后感染发生例数分别为25、40例，其中感染肺炎克雷伯杆菌、金黄色葡萄球菌、念珠菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌例数无激素组分别为18、3、2、2、0例，激素组分别为26、6、3、3、2例，两组比较，差异有统计学意义（χ^2=10.149，P〈0.05）。两组术后发生感�Objective：To investigate the clinical efficacy of basiliximabinduced glucosefree corticosteroid immunosuppressive regimen after liver transplantation. Methods：The retrospective cohort study was conducted. The clinicopathological data of 227 patients with liver transplantation who were admitted to Bayi Hospital affiliated to Nanjing University of Traditional Chinese Medicine from January 2010 to October 2016 were collected. Of the 227 patients, 125 who postoperatively received a glucosefree corticosteroid immunosuppressive regimen using a monoclonal antibody ＋ tacrolimus ＋ mycophenolate mofetil tablets were allocated into the hormonefree group, and 102 who were postoperatively treated with the immunosuppressive regimen using glucocorticoid steroid ＋ tacrolimus ＋ mycophenolate mofetil tablets were allocated into the hormone group. Observation indicators： （1） comparison of followup and survival; （2） comparison of postoperative infection, rejection and biliary stenosis between groups. Followup using outpatient examination and telephone interview was performed to detect postoperative survival, infection, rejection and biliary stenosis up to June 2017. The measurement data with normal distribution were represented as ±s, and comparison between groups was done by the t test. Measurement data with skewed distribution were described as M （P25, P75） and M （range）, and comparison between groups was analyzed using the rank sum test. The count data were compared by the chisquare test. Kaplan-meier method was used to draw survival curve and calculated survival rate. Log-rank test was used for survival analysis. Results：（1） Comparison of followup and survival： patients between groups were followed up for 9-89 months, with a median time of 45 months. The 1 and 3year overall survival rates were respectively 93.25%, 85.24% in the hormonefree group and 89.89 %, 74.22% in the hormone group, with a statistically significant difference （χ^2=8.450, P〈0.05）. （2） Comparison of postoperati

关 键 词：肝移植 免疫抑制 巴利昔单克隆抗体 糖皮质类固醇激素 排斥反应 胆道狭窄 

分 类 号：R657.3[医药卫生—外科学]