肝硬化或肝癌伴银屑病患者肝移植术后免疫抑制剂的治疗经验  

Experience of immunosuppressive therapy after liver transplantation in patients with cirrhosis or liver cancer with psoriasis

作　　者：宫学宇 李怀朋 刘帅 何龙 杨宏伟 杜国盛 Gong Xueyu;Li Huaipeng;Liu Shuai;He Long;Yang Hongwei;Du Guosheng(Department of Organ Transplantation Center,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院器官移植中心,沈阳110016

出　　处：《中国临床实用医学》2024年第6期13-15,共3页China Clinical Practical Medicine

基　　金：辽宁省科学技术计划项目(2021JH2/10300089)。

摘　　要：目的探讨肝硬化或肝癌伴银屑病患者肝移植术后免疫抑制剂的治疗经验。方法本研究为回顾性病例系列分析研究,选取2000年1月至2024年1月北部战区总医院器官移植中心收治的6例肝移植的银屑病患者,男4例,女2例,年龄(52±3)岁,年龄范围为48~55岁。比较患者治疗前、后银屑病皮损面积和严重性指数(PASI)评分,分析不同免疫抑制剂对PASI评分的影响。结果治疗后,2例乙型肝炎后肝硬化患者,银屑病皮损减少,PASI评分逐渐下降。治疗后4周,另4例乙型肝炎后肝硬化合并肝癌肝移植患者逐步转换为西罗莫司为主的免疫抑制剂方案。其中,2例患者治疗后4周内全身皮损逐渐增多,炎症逐渐加重,鳞屑逐渐增加,PASI评分逐渐增加,转换为西罗莫司治疗后,银屑病斑块面积减少,PASI评分逐渐减少。本研究6例患者的治疗前、治疗后4周的PASI评分[(39.14±5.46)分、(30.17±11.58)分]比较,差异无统计学意义(P>0.05);治疗后8周,6例患者的PASI评分[(11.83±4.58)分]显著低于治疗前[(39.14±5.46)分],差异有统计学意义(P<0.05)。结论西罗莫司在肝移植术后预防排斥的情况下,对肝移植伴银屑病有一定的治疗效果。ObjectiveTo investigate the experience of immunosuppressive therapy after liver transplantation in patients with cirrhosis or liver cancer with psoriasis.MethodsThis study was a retrospective case series analysis,a total of 6 patients with psoriasis who underwent liver transplantation were selected from the department of Organ Transplantation Center at General Hospital of Northern Theater Command from January 2000 to January 2024,including 4 males and 2 females,aged(52±3)years old,the age ranging from 48 to 55 years old.Psoriasis area and severity index(PASI)scores were compared before and after treatment,and the effects of different immunosuppressants on PASI scores were analyzed.ResultsAfter treatment,psoriasis lesions were reduced and PASI scores were gradually decreased in 2 patients with posthepatitis B cirrhosis.Treatment for 4 weeks,another four liver transplant patients with posthepatitis B cirrhosis combined with liver cancer were progressively switched to sirolimus-based immunosuppressant regimen.Among them,in 2 patients,systemic skin lesions,inflammation,scales and PASI scores gradually increased within 4 weeks after treatment.After conversion to sirolimus treatment,psoriasis plaque area decreased and PASI scores gradually decreased.In this study,the PASI scores before and after 4 weeks of treatment[(39.14±5.46)points]and[(30.17±11.58)points]in the 6 patients were compared,with no statistical significance(P>0.05).At 8 weeks after treatment,the PASI score of 6 patients[(11.83±4.58)points]was significantly lower than that before treatment[(39.14±5.46)points],and the difference was statistically significant(P<0.05).ConclusionsSirolimus has a certain therapeutic effect on psoriasis associated with liver transplantation in the case of preventing rejection after liver transplantation.

关 键 词：肝移植 银屑病 西罗莫司 免疫抑制剂 

分 类 号：R735.7[医药卫生—肿瘤] R758.63[医药卫生—临床医学]