免疫状态量化评估体系指导肝移植术后个体化免疫抑制药管理的临床应用探讨  

Clinical application investigation of quantitative evaluation system of immune status in guiding individualized management of immunosuppressants after liver transplantation

作　　者：贾亚男 朱继巧[1] 李瀚 许文犁 王若麟 吕少诚[1] 寇建涛[1] 李先亮[1] 贺强[1] Jia Yanan;Zhu Jiqiao;Li Han;Xu Wenli;Wang Ruolin;Lyu Shaocheng;Kou Jiantao;Li Xianliang;He Qiang(Department of Hepatobiliary-pancreatic-splenic Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院肝胆胰脾外科,北京100020

出　　处：《器官移植》2022年第6期803-809,共7页Organ Transplantation

基　　金：北京市自然科学基金(7212042);首都医科大学附属北京朝阳医院科技创新基金(21kcjj-4)。

摘　　要：目的探讨免疫状态量化评估体系对肝移植术后受者免疫抑制药个体化管理的指导作用。方法回顾性分析239例肝移植受者的临床资料,建立铭道免疫细胞状态全面评估体系(MICA),根据免疫抑制药的调整方法将受者分为两组,其中根据铭道免疫状态量化评分标准(MISS)评分调整免疫抑制药用药方案的为MISS评分组(84例),同期按经验性用药调整用药方案的为常规对照组(155例)。在MISS评分组中,根据术后检测时间(t)将受者分为A组(t≤28 d,78例次)、B组(28 d<t≤6个月,68例次)、C组(6个月<t≤12个月,18例次)、D组(12个月<t≤24个月,18例次)和E组(t>24个月,19例次)。分析MISS评分组中A~E组受者术后MISS评分情况、比较两组受者急性排斥反应和机会性感染的发生情况以及总体生存率。结果A~E组的MISS评分分别为-7.0(-13.2,-2.0)分、-2.0(-5.8,1.8)分、-0.5(-7.3,2.8)分、-2.0(-4.5,3.3)分、-3.0(-6.0,1.0)分,受者的免疫状态随术后时间的延长而逐渐改善,组间比较差异有统计学意义(P<0.05)。MISS评分组受者中有15%(13/84)发生急性排斥反应,常规对照组受者中有27%(42/155)发生急性排斥反应,差异有统计学意义(P<0.05)。在MISS评分组中,发生急性排斥反应的受者MISS评分为0(-2.5,3.5)分,未发生急性排斥反应的受者为-5.0(-12.0,-1.0)分,差异有统计学意义(P<0.05)。MISS评分组受者中有2%(2/84)发生术后机会性感染,常规对照组受者中有9%(14/155)发生术后机会性感染,差异有统计学意义(P<0.05)。MISS评分组受者1年、3年总体生存率分别为86.9%、79.8%,常规对照组分别为83.2%、76.8%,两组受者术后总体生存率差异无统计学意义(P>0.05)。结论应用MICA免疫状态分析和MISS免疫评分能够反映肝移植受者免疫状态,指导肝移植受者术后免疫抑制药个体化应用管理。Objective To investigate the guiding role of quantitative evaluation system of immune status in the individualized management of immunosuppressants for the recipients after liver transplantation.Methods Clinical data of 239 liver transplant recipients were retrospectively analyzed.MingDao Immune Cell Analysis(MICA)was established.All recipients were divided into two groups according to the adjustment regimens of immunosuppressants.The immunosuppressant regimen was adjusted according to MingDao Immune System Score(MISS)in the MISS group(n=84),and the medication plan was empirically adjusted during the same period in the control group(n=155).According to the time of postoperative detection(t),the recipients in the MISS group were divided into subgroup A(t≤28 d,n=78),subgroup B(28 d<t≤6 months,n=68),subgroup C(6 months<t≤12 months,n=18),subgroup D(12 months<t≤24 months,n=18)and subgroup E(t>24 months,n=19).In the MISS group,postoperative MISS scores of recipients in subgroups A-E were analyzed.The incidence of acute rejection and opportunistic infection and the overall survival rate were statistically compared between the MISS and control groups.Results The MISS scores in subgroups A-E were-7.0(-13.2,-2.0),-2.0(-5.8,1.8),-0.5(-7.3,2.8),-2.0(-4.5,3.3)and-3.0(-6.0,1.0),respectively.The immune status of the recipients was gradually improved over postoperative time,and the difference between two groups was statistically significant(P<0.05).In the MISS group,15%(13/84)of the recipients developed acute rejection,and 27%(42/155)in the control group,and the difference was statistically significant(P<0.05).In the MISS group,the MISS score of the recipients with acute rejection was 0(-2.5,3.5),and-5.0(-12.0,-1.0)for their counterparts without acute rejection,and the difference was statistically significant(P<0.05).In the MISS group,2%(2/84)of the recipients presented with postoperative opportunistic infection,and 9%(14/155)in the control group,and the difference was statistically significant(P<0.05).In the MISS group,

关 键 词：免疫状态评估 免疫评分 肝移植 免疫抑制药管理 排斥反应 机会性感染 淋巴细胞亚群 流式细胞术 铭道免疫细胞状态全面评估体系 铭道免疫状态量化评分标准 

分 类 号：R617[医药卫生—外科学] R392.4[医药卫生—临床医学]