CAJ | 학술논문

目的研究霉酚酸酯（MMF）类药物在儿童肝移植中应用的有效性及安全性。方法回顾性分析天津市第一中心医院2013年8月至2014年8月间进行肝移植手术后18例患儿的临床资料，对其中12例加用MMF药物治疗的患儿进行观察。结果18例肝移植患儿中除1例患儿术后2周出现胆肠吻合肠袢肠瘘，其余17例患儿均未出现严重外科并发症。8例患儿因为急性排斥反应而加用MMF，4例患儿因他克莫司血药浓度偏低加用MMF。8例存在急性排斥反应的患儿，加用MMF后丙氨酸转氨酶（ALT）显著下降（39 U/L比233 U/L，P＝0.007）；天冬氨酸转氨酶（AST）、总胆红素（TBil）、碱性磷酸酶（ALP）均较加用MMF前降低，但差异无统计学意义（P值分别为0.05、0.19和0.06）。随访至2014年9月，所有患儿肝功能均恢复正常。6例未加用MMF的患儿中，2例出现EB病毒（EBV）感染，而在12例加用MMF后患儿中，有3例出现EBV感染，其中2例合并巨细胞病毒（CMV）感染。1例患儿加用MMF后出现药物性腹泻。所有病例均未出现明显的骨髓抑制。虽然有EBV感染病例，但未出现移植后淋巴增殖性疾病（PTLD），也没有其他恶性肿瘤发生。结论 MMF在儿童肝移植中是有效的免疫抑制剂，对于急性排斥反应的治疗及预防均有作用，而其毒副作用并未在患儿中有明显表现。
목적연구매분산지（MMF）류약물재인동간이식중응용적유효성급안전성。방법회고성분석천진시제일중심의원2013년8월지2014년8월간진행간이식수술후18례환인적림상자료，대기중12례가용MMF약물치료적환인진행관찰。결과18례간이식환인중제1례환인술후2주출현담장문합장번장루，기여17례환인균미출현엄중외과병발증。8례환인인위급성배척반응이가용MMF，4례환인인타극막사혈약농도편저가용MMF。8례존재급성배척반응적환인，가용MMF후병안산전안매（ALT）현저하강（39 U/L비233 U/L，P＝0.007）；천동안산전안매（AST）、총담홍소（TBil）、감성린산매（ALP）균교가용MMF전강저，단차이무통계학의의（P치분별위0.05、0.19화0.06）。수방지2014년9월，소유환인간공능균회복정상。6례미가용MMF적환인중，2례출현EB병독（EBV）감염，이재12례가용MMF후환인중，유3례출현EBV감염，기중2례합병거세포병독（CMV）감염。1례환인가용MMF후출현약물성복사。소유병례균미출현명현적골수억제。수연유EBV감염병례，단미출현이식후림파증식성질병（PTLD），야몰유기타악성종류발생。결론 MMF재인동간이식중시유효적면역억제제，대우급성배척반응적치료급예방균유작용，이기독부작용병미재환인중유명현표현。
Objective To study the efficacy and safety of mycophenolate mofetil(MMF)in pediatric liver transplantation. Methods We retrospectively analyzed the clinical data of 18 cases of pediatric liver transplantations performed from August 2013 to August 2014 in Tianjin first central hospital,of which 12 cases were treated with MMF. Results Among these 18 recipients,1 suffered biliary-enteric anastomosis intestinal fistula 2 weeks after operation,and no severe surgical complications were observed in other 17 cases. MMF was administrated in 8 cases for acute rejection and 4 cases for low tacrolimus concentration. Alanine aminotransferase (ALT)decreased significantly in those 8 recipients with acute rejection after administration of MMF(39 U/L vs. 233 U/L,P=0.007). Aspartate aminotransferase(AST),total bilirubin(TBil)and alkaline phosphatase(ALP) also decreased,but there were no statistically significant differences(P value were 0.05,0.19 and 0.06 respectively). Liver function was normal in all cases till September 2014. In 6 recipients without administration of MMF,2 cases suffered EB virus infection,while in 12 recipients with administration of MMF,3 cases suffered EB virus infection with 2 out of these 3 with cytomegalovirus infection. 1 case suffered MMF-induced diarrhea. Bone marrow suppression was not observed in all cases. Despite the EB virus infection,no posttransplant lymphoproliferative disorders(PTLD) <br> and other malignant tumors were observed in this cohort. Conclusion MMF is an effective immunosuppressant for treatment and prevention of acute rejection in pediatric liver transplantation without significant side effects.