肝移植术后耐激素性急性排斥反应的诊疗现状  

Current status of diagnosis and treatment of steroid resistant acute rejection after liver transplantation

作　　者：彭华彬 孙丽莹[2] Peng Huabin;Sun Liying(Department of Intensive Liver Disease,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;不详)

机构地区：[1]首都医科大学附属北京友谊医院重症肝病科,北京100050 [2]首都医科大学附属北京友谊医院肝脏移植中心、首都医科大学儿童肝脏移植临床诊疗与研究中心、国家消化系统疾病临床医学研究中心

出　　处：《器官移植》2025年第1期156-162,共7页Organ Transplantation

基　　金：国家自然科学基金面上项目(82270685)。

摘　　要：实体器官移植术后急性排斥反应的发生后常采用大剂量糖皮质激素(激素)冲击治疗,但大剂量激素冲击治疗对部分患者无效,即耐激素性急性排斥反应,易导致移植物丢失,严重影响患者预后。目前认为细胞介导排斥反应和抗体介导排斥反应均参与了耐激素性急性排斥反应的发生发展。肾移植术后耐激素性急性排斥反应的诊断与治疗已比较成熟,而肝移植术后耐激素性急性排斥反应国内以往关注较少,目前尚未形成统一规范的治疗方案。因此,本文就肝移植术后耐激素性急性排斥反应的发病机制、诊断及治疗进行综述,以期为肝移植术后耐激素性急性排斥反应的诊疗提供参考。After the occurrence of acute rejection following solid organ transplantation,high-dose glucocorticoid(steroid)pulse therapy is commonly used.However,high-dose steroid pulse therapy is ineffective for some patients,leading to steroid resistant acute rejection,which may easily result in graft loss and severely affect patient prognosis.It is currently believed that both cell-mediated rejection and antibody-mediated rejection are involved in the occurrence and development of steroid resistant acute rejection.The diagnosis and treatment of steroid resistant acute rejection after kidney transplantation have become relatively mature,while the focus on steroid resistant acute rejection after liver transplantation has been relatively low in the past in China,and a unified standardized treatment plan has not yet been formed.Therefore,this article reviews the pathogenesis,diagnosis,and treatment of steroid resistant acute rejection after liver transplantation,in order to provide a reference for the diagnosis and treatment of steroid resistant acute rejection after liver transplantation.

关 键 词：肝移植 急性排斥反应 耐激素性 T细胞介导排斥反应 抗体介导排斥反应 供者特异性抗体 他克莫司 吗替麦考酚酯 

分 类 号：R617[医药卫生—外科学] R977.1[医药卫生—临床医学]