中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2013年
11期
671-675
,共5页
肝移植%钙调磷酸酶抑制剂%糖皮质激素%肝细胞肝癌%糖尿病%移植物排斥
肝移植%鈣調燐痠酶抑製劑%糖皮質激素%肝細胞肝癌%糖尿病%移植物排斥
간이식%개조린산매억제제%당피질격소%간세포간암%당뇨병%이식물배척
Liver transplantation%Calcineurin inhibitors%Glucocorticoids%Hepatocellular carcinoma%Diabetes mellitus%Graft rejection
目的 比较肝移植后维持期无皮质激素的免疫抑制方案与常规免疫抑制方案的有效性、安全性和长期效果.方法 以2003年1月至2009年12月间在单中心接受肝移植的肝细胞肝癌患者为研究对象,其中78例术中应用甲泼尼龙500 mg,术后应用他克莫司+吗替麦考酚酯(MMF)+巴利昔单抗预防排斥反应(无激素组);100例术后应用他克莫司+MMF+皮质激素预防排斥反应(激素组).观察两组受者肝移植相关并发症、代谢性并发症、受者和移植肝存活率及肿瘤复发情况等.结果 无激素组移植后新发糖尿病发生率为38.7％,长期糖尿病发生率为4.0％,低于激素组的91.0％和30.3％(P＜0.05).无激素组和激素组的平均存活期(50.8个月和64.2个月)及肿瘤无复发存活期(19.6个月和23.8个月)的差异无统计学意义(P＞0.05);无激素组和激素组的受者5年存活率(42.5％和50.5％)及肿瘤无复发存活率(38.9％和39.2％)的差异也无统计学意义(P＞0.05).无激素组符合米兰标准者的5年存活率优于激素组(88.9％和57.4％,P=0).022).结论 肝癌肝移植受者合理应用无皮质激素的免疫抑制方案并不增加急性排斥反应的发生率,移植后糖尿病发生率低于采用皮质激素治疗者,符合米兰标准的受者的存活情况较好.
目的 比較肝移植後維持期無皮質激素的免疫抑製方案與常規免疫抑製方案的有效性、安全性和長期效果.方法 以2003年1月至2009年12月間在單中心接受肝移植的肝細胞肝癌患者為研究對象,其中78例術中應用甲潑尼龍500 mg,術後應用他剋莫司+嗎替麥攷酚酯(MMF)+巴利昔單抗預防排斥反應(無激素組);100例術後應用他剋莫司+MMF+皮質激素預防排斥反應(激素組).觀察兩組受者肝移植相關併髮癥、代謝性併髮癥、受者和移植肝存活率及腫瘤複髮情況等.結果 無激素組移植後新髮糖尿病髮生率為38.7％,長期糖尿病髮生率為4.0％,低于激素組的91.0％和30.3％(P＜0.05).無激素組和激素組的平均存活期(50.8箇月和64.2箇月)及腫瘤無複髮存活期(19.6箇月和23.8箇月)的差異無統計學意義(P＞0.05);無激素組和激素組的受者5年存活率(42.5％和50.5％)及腫瘤無複髮存活率(38.9％和39.2％)的差異也無統計學意義(P＞0.05).無激素組符閤米蘭標準者的5年存活率優于激素組(88.9％和57.4％,P=0).022).結論 肝癌肝移植受者閤理應用無皮質激素的免疫抑製方案併不增加急性排斥反應的髮生率,移植後糖尿病髮生率低于採用皮質激素治療者,符閤米蘭標準的受者的存活情況較好.
목적 비교간이식후유지기무피질격소적면역억제방안여상규면역억제방안적유효성、안전성화장기효과.방법 이2003년1월지2009년12월간재단중심접수간이식적간세포간암환자위연구대상,기중78례술중응용갑발니룡500 mg,술후응용타극막사+마체맥고분지(MMF)+파리석단항예방배척반응(무격소조);100례술후응용타극막사+MMF+피질격소예방배척반응(격소조).관찰량조수자간이식상관병발증、대사성병발증、수자화이식간존활솔급종류복발정황등.결과 무격소조이식후신발당뇨병발생솔위38.7％,장기당뇨병발생솔위4.0％,저우격소조적91.0％화30.3％(P＜0.05).무격소조화격소조적평균존활기(50.8개월화64.2개월)급종류무복발존활기(19.6개월화23.8개월)적차이무통계학의의(P＞0.05);무격소조화격소조적수자5년존활솔(42.5％화50.5％)급종류무복발존활솔(38.9％화39.2％)적차이야무통계학의의(P＞0.05).무격소조부합미란표준자적5년존활솔우우격소조(88.9％화57.4％,P=0).022).결론 간암간이식수자합리응용무피질격소적면역억제방안병불증가급성배척반응적발생솔,이식후당뇨병발생솔저우채용피질격소치료자,부합미란표준적수자적존활정황교호.
Objective To evaluate the efficacy and safety of using basiliximab in place of a corticosteroid for immunosuppression following liver transplantation for hepatocellular carcinoma (HCC) in Chinese patients.Method The records of 178 patients with HCC who underwent orthotopic liver transplantation from January 2003 to December 2009 were retrospectively reviewed.All patients received immunosuppression therapy that contained either basiliximab (n =78) or steroids (n =100) in addition to tacrolimus and mycophenolate mofetil.Assessments included complications related to liver transplantation,occurrence of steroid side effects,recurrence of HCC,and patient and graft survival.Results A smaller proportion of patients receiving basiliximab than steroids experienced de novo diabetes (38.7％ vs.91.0％,respectively) or long-term de novo diabetes mellitus (4.0％ vs.30.3％,respectively) (both,P＜0.0001).The median overall and disease free survival was similar between basiliximab (50.8 months and 19.6 months,respectively) and steroid treated patients (64.2 months and 23.8 months,respectively).The 5-year overall survival and disease free survival rate was also similar between the basiliximab (42.5％ and 38.9％,respectively) and steroid (50.5％ and 39.2％) groups (all,P＞0.730).However,in patients who met the Milan criteria basiliximab was associated with greater 5 year overall survival rate than steroid therapy (88.9％ vs.57.4％,respectively,P =0.022).Conclusion It revealed that the non-steroid treatment does not increase the incidence of acute rejection but also can decrease the incidence of de novo diabetes in the patients with HCC following liver transplantation and prolong the survival time of patients who met the Milan criteria.
