中国组织工程研究与临床康复
中國組織工程研究與臨床康複
중국조직공정연구여림상강복
JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
2011年
18期
3408-3412
,共5页
巫林伟%张剑威%邰强%鞠卫强%何晓顺%郭志勇%王东平%朱晓峰%马毅%王国栋%王长希%胡安斌
巫林偉%張劍威%邰彊%鞠衛彊%何曉順%郭誌勇%王東平%硃曉峰%馬毅%王國棟%王長希%鬍安斌
무림위%장검위%태강%국위강%하효순%곽지용%왕동평%주효봉%마의%왕국동%왕장희%호안빈
胰肾联合移植%排斥反应%免疫抑制剂%糖尿病肾病%器官移植
胰腎聯閤移植%排斥反應%免疫抑製劑%糖尿病腎病%器官移植
이신연합이식%배척반응%면역억제제%당뇨병신병%기관이식
背景:胰肾联合移植已经被公认为是糖尿病(包括1 型和2 型)合并终末期尿毒症的有效治疗手段,由于胰腺为高免疫原性器官,合理的免疫抑制治疗是保证胰腺移植成功的关键.目的:探讨胰肾一期联合移植后免疫抑制药物的合理应用.方法:纳入2005-01/2009-06 在中山大学附属第一医院器官移植中心完成胰肾一期联合移植的患者9 例,其中男5 例,女4 例,胰液引流均采用空肠引流方式.术后采用白细胞介素2 单克隆抗体诱导的四联免疫抑制方案:白细胞介素2 单克隆抗体+他克莫司+麦考酚酸+激素,并逐渐过渡至单用他克莫司维持治疗.回顾性分析以上9 例患者围手术期及长期随访情况.结果与结论:胰肾一期联合移植后,除1 例早期死亡外,其余8 例患者移植后1 周内肌酐降至正常水平,移植后停用胰岛素时间为(11.5±3.5) d,空腹血糖恢复至正常时间为(15.4±6.3) d.8 例患者随访4～50 个月期间,共有4 例发生移植肾急性排斥,其中1 例在接受床边血液透析过程中并发心脑血管意外后家属放弃治疗,其余3 例患者经抗胸腺细胞球蛋白或激素冲击治疗后移植肾功能均逆转恢复,随访过程中未发现移植胰腺排斥.说明胰肾联合移植是治疗糖尿病合并终末期糖尿病肾病的有效方法,术后早期采用白细胞介素2 单克隆抗体诱导的四联免疫抑制方案并逐渐过渡至单用他克莫司维持治疗是安全的.
揹景:胰腎聯閤移植已經被公認為是糖尿病(包括1 型和2 型)閤併終末期尿毒癥的有效治療手段,由于胰腺為高免疫原性器官,閤理的免疫抑製治療是保證胰腺移植成功的關鍵.目的:探討胰腎一期聯閤移植後免疫抑製藥物的閤理應用.方法:納入2005-01/2009-06 在中山大學附屬第一醫院器官移植中心完成胰腎一期聯閤移植的患者9 例,其中男5 例,女4 例,胰液引流均採用空腸引流方式.術後採用白細胞介素2 單剋隆抗體誘導的四聯免疫抑製方案:白細胞介素2 單剋隆抗體+他剋莫司+麥攷酚痠+激素,併逐漸過渡至單用他剋莫司維持治療.迴顧性分析以上9 例患者圍手術期及長期隨訪情況.結果與結論:胰腎一期聯閤移植後,除1 例早期死亡外,其餘8 例患者移植後1 週內肌酐降至正常水平,移植後停用胰島素時間為(11.5±3.5) d,空腹血糖恢複至正常時間為(15.4±6.3) d.8 例患者隨訪4～50 箇月期間,共有4 例髮生移植腎急性排斥,其中1 例在接受床邊血液透析過程中併髮心腦血管意外後傢屬放棄治療,其餘3 例患者經抗胸腺細胞毬蛋白或激素遲擊治療後移植腎功能均逆轉恢複,隨訪過程中未髮現移植胰腺排斥.說明胰腎聯閤移植是治療糖尿病閤併終末期糖尿病腎病的有效方法,術後早期採用白細胞介素2 單剋隆抗體誘導的四聯免疫抑製方案併逐漸過渡至單用他剋莫司維持治療是安全的.
배경:이신연합이식이경피공인위시당뇨병(포괄1 형화2 형)합병종말기뇨독증적유효치료수단,유우이선위고면역원성기관,합리적면역억제치료시보증이선이식성공적관건.목적:탐토이신일기연합이식후면역억제약물적합리응용.방법:납입2005-01/2009-06 재중산대학부속제일의원기관이식중심완성이신일기연합이식적환자9 례,기중남5 례,녀4 례,이액인류균채용공장인류방식.술후채용백세포개소2 단극륭항체유도적사련면역억제방안:백세포개소2 단극륭항체+타극막사+맥고분산+격소,병축점과도지단용타극막사유지치료.회고성분석이상9 례환자위수술기급장기수방정황.결과여결론:이신일기연합이식후,제1 례조기사망외,기여8 례환자이식후1 주내기항강지정상수평,이식후정용이도소시간위(11.5±3.5) d,공복혈당회복지정상시간위(15.4±6.3) d.8 례환자수방4～50 개월기간,공유4 례발생이식신급성배척,기중1 례재접수상변혈액투석과정중병발심뇌혈관의외후가속방기치료,기여3 례환자경항흉선세포구단백혹격소충격치료후이식신공능균역전회복,수방과정중미발현이식이선배척.설명이신연합이식시치료당뇨병합병종말기당뇨병신병적유효방법,술후조기채용백세포개소2 단극륭항체유도적사련면역억제방안병축점과도지단용타극막사유지치료시안전적.
BACKGROUND: Simultaneous pancreas and kidney transplantation (SPK) has been considered an effective therapeutic means of diabetes mellitus (including type 1 and type 2) combined with end stage uremia. Because the pancreas possesses high immunogenicity, so a feasible immunosuppressive regimen is a key to successful pancreas transplantation. OBJECTIVE: To investigate the feasible immunosuppressive regimen after simultaneous pancreas and kidney transplantation (SPK). METHODS: From January 2005 to June 2009, 9 patients with diabetic nephropathy and end stage uremia, consisting of 5 males and 4 females, received SPK. The pancreatic allograft exocrine secretion was drained into the proximal jejunum via a side-to-side duodenojujunostomy. Quadruple immunosuppressive regimen including induction of interleukin-2 receptor monoclonal antibody, tacrolimus, mycophenolate mofetil and steroid, and gradual tacrolimus monotherapy. The clinical data of the 9 patients were analyzed retrospectively. RESULTS AND CONCLUSION: SPK was successfully applied to all patients without serious surgical complications such as pancreatitis, graft dysfunction and pancreatic fistula. One patient died of cardiovascular accident in the early stage after SPK. The other 8 patients were followed up for 4-50 months. Serum creatinine decreased to normal range within 1 week after surgery. The 8 patients achieved euglycemia during early postoperative stage with insulin independence time (11.5±3.5) days and with fasting blood glucose recovery time (15.4±6.3) days. Acute rejection of the renal graft occurred in 4 patients, 1 patient died of cardiovascular accident and the other 3 recovered after antihuman thymocyte globulin or steroids bolus treatment. No rejection was noted in pancreatic grafts. These findings indicate that SPK is an effective treatment for patients with diabetes mellitus-related middle- and end-stage uremia．Quadruple immunosuppressive regime including interleukin-2 receptor monoclonal antibody induction is feasible after SPK, and such a regimen can be safely converted to tacrolimus monotherapy.
