CAJ | 학술논문

背景:国内外均出现了肾移植后联合应用单克隆抗体的早期激素撤停或半量激素应用方案,研究发现减少激素应用并未明显增加排斥反应的发生,但能否将单克隆抗体完全替代激素的方案安全有效地应用于肝移植患者,目前较少见报道.目的:对肝移植患者应用无激素和早期激素撤停两种免疫抑制方案的观察,评价两种方案的临床疗效及安全性.方法:肝癌肝移植患者80例,其中33例患者应用巴利昔单抗诱导的无激素免疫抑制方案(他克莫司+酶酚酸酯+巴利昔单抗)作为实验组;另47例患者应用早期激素撤停方案(他克莫司+酶酚酸酯+激素)作为对照组.对照组激素于移植后第1天以后逐日减量,至移植后1个月停用.随访观察两组患者排斥率、感染率、1年内肿瘤复发率及1年生存率.结果与结论:实验组患者感染率、1年内肿瘤复发率明显低于对照组(P<0.05);两组患者排斥反应发生率及1年生存率差异无显著性意义(P>0.05).结果提示肝癌肝移植患者可以安全有效的应用无激素的巴利昔单抗免疫抑制方案,移植后感染率、肿瘤复发率明显低于激素治疗方案,并且不增加急性排斥反应的发生率.
배경:국내외균출현료신이식후연합응용단극륭항체적조기격소철정혹반량격소응용방안,연구발현감소격소응용병미명현증가배척반응적발생,단능부장단극륭항체완전체대격소적방안안전유효지응용우간이식환자,목전교소견보도.목적:대간이식환자응용무격소화조기격소철정량충면역억제방안적관찰,평개량충방안적림상료효급안전성.방법:간암간이식환자80례,기중33례환자응용파리석단항유도적무격소면역억제방안(타극막사+매분산지+파리석단항)작위실험조;령47례환자응용조기격소철정방안(타극막사+매분산지+격소)작위대조조.대조조격소우이식후제1천이후축일감량,지이식후1개월정용.수방관찰량조환자배척솔、감염솔、1년내종류복발솔급1년생존솔.결과여결론:실험조환자감염솔、1년내종류복발솔명현저우대조조(P<0.05);량조환자배척반응발생솔급1년생존솔차이무현저성의의(P>0.05).결과제시간암간이식환자가이안전유효적응용무격소적파리석단항면역억제방안,이식후감염솔、종류복발솔명현저우격소치료방안,병차불증가급성배척반응적발생솔.
BACKGROUND: Recently emerged immunosuppressive scheme combined with basiliximab following liver transplantation, such as the early steroid withdrawal or half amount of steroid. Many studies demonstrated that it would not increase the rejection rate in reducing the use of steroid. However, there were rare reports addressing whether it was safe and effective to replace the steroid by basiliximab. OBJECTIVE: Through the application of non-steroid and early steroid withdrawal immunosuppressive scheme in patients of hepatocellular carcinoma following liver transplantation, to evaluate the therapeutic effect and safety of two treatments. METHODS: A total of 80 patients of hepatocellular carcinoma receiving liver transplantation were divided into the experimental and control group. In the experimental group, 33 patients were applied with non-steroid treatment (Tacrolimus+mycophenolate mofetil+basiliximab); additionally 47 patients were applied with early steroid withdrawal treatment (Tacrolimus+mycophenolate mofetil+ steroid). Steroid was reduced gradually from the first day after transplantation to discontinuation after 1 month. The rates of rejection, infection, cancer recurrence and 1 -year survival were measured. RESULTS AND CONCLUSION: Compared to the control group, the rates of infection and cancer recurrence were significantly smaller in the experimental group (P < 0.05). However, there was no significantly difference between 2 groups in the rates of rejection and 1 -year survival (P > 0.05). It revealed that the non-steroid treatment can be safely and effectively applied in the patients with hepatocellular carcinoma following liver transplantation. The non-steroid treatment can significantly cut down the infection rate and cancer recurrence rate, which has no effect on the rejection and 1 -year survival rate.