CAJ | 학술논문

目的探讨无皮质激素的免疫抑制方案对原位肝移植术后近期急性排斥反应发生率的影响.方法采用随机数字表法将186例肝移植受者分为两组.无皮质激素组(研究组)术后均采用他克莫司(Tac)[或环孢素A(CsA)]+吗替麦考酚酯(MMF)的免疫抑制方案,未使用皮质激素；有皮质激素组(对照组)术后均采用Tac(或CsA)+MMF+皮质激素的三联免疫抑制方案.观察术后6个月内两组间急性排斥反应发生率的差异.急性排斥反应的诊断参照Banff标准.结果两组受者间性别、年龄、原发病、Child-Pugh评分、终末期肝病模型(MELD)评分、手术时间、术中出血量、输注红细胞悬液及供肝热、冷缺血时间等基本资料的比较,差异均无统计学意义(P＞0.05).观察期内,研究组和对照组接受移植肝穿刺活检各9例次,诊断为急性排斥反应者分别为5和4例,发生率分别为5.3％ (5/94)和4.4％(4/92),两组间比较,差异有统计学意义(P＜0.05).结论肝移植术后采用无皮质激素的免疫抑制方案不会增加近期(半年内)急性排斥反应的发生率.
목적 탐토무피질격소적면역억제방안대원위간이식술후근기급성배척반응발생솔적영향.방법 채용수궤수자표법장186례간이식수자분위량조.무피질격소조(연구조)술후균채용타극막사(Tac)[혹배포소A(CsA)]+마체맥고분지(MMF)적면역억제방안,미사용피질격소；유피질격소조(대조조)술후균채용Tac(혹CsA)+MMF+피질격소적삼련면역억제방안.관찰술후6개월내량조간급성배척반응발생솔적차이.급성배척반응적진단삼조Banff표준.결과 량조수자간성별、년령、원발병、Child-Pugh평분、종말기간병모형(MELD)평분、수술시간、술중출혈량、수주홍세포현액급공간열、랭결혈시간등기본자료적비교,차이균무통계학의의(P＞0.05).관찰기내,연구조화대조조접수이식간천자활검각9례차,진단위급성배척반응자분별위5화4례,발생솔분별위5.3％ (5/94)화4.4％(4/92),량조간비교,차이유통계학의의(P＜0.05).결론 간이식술후채용무피질격소적면역억제방안불회증가근기(반년내)급성배척반응적발생솔.
Objective To investigate the short-term acute rejection incidence of the recipients under the steroid-free immunosuppressive therapy after liver transplantation. Methods This retrospective study included 186 patients who were divided into two groups by random number table.The patients in no steroid group (the study group, n =94) received tacrolimus (Tac) with mycophemolate mofetil (MMF) or cyclosporine with MMF,and those in the steroid group (the control group,n =92) received the aforementioned immunosuppressive therapy combined with steroids.The acute rejection incidence was analyzed during six months post-transplantation.Results There was no significant difference in the gender,age,indication for transplantation,Child-Pugh score,MELD score,operating time,bleeding and transfusion volume during the operation,warm ischemia time and cold ischemia time between the two groups (P＞0.05).Liver biopsy was done on 9 cases of each group.The acute rejection incidence had no significant difference between the study group and the control group (5/94 vs 4/92,5.3％ vs 4.4％,P＞0.05).Conclusion The steroid-free immunosuppressive therapy after liver transplantation did not increase the short term acute rejection incidence.