CAJ | 학술논문

目的：探讨复方磺胺甲唑和皮质类固醇激素对心脏移植术后感染并发症的影响。方法选取本院2011年1月至2013年3月实施同种异体原位心脏移植62例患者为研究对象，62例患者中6例失访，其余56例患者分为空白对照组（23例）、参考对照组（14例）和干预组（19例）。三组患者均采取相同的免疫抑制方案（他克莫司＋霉酚酸酯＋皮质类固醇激素）。空白对照组患者保持免疫抑制方案不变，不进行其他干预；参考对照组患者术后3个月内停用皮质类固醇激素；干预组患者术后3个月内停用皮质类固醇激素，同时口服复方磺胺甲唑。术后均随访6～24个月，评估三组患者心脏移植术后生存率、移植心脏排斥反应发生率以及感染、高血脂、高血糖等并发症发生率。结果干预组患者感染发生率显著低于参考对照组和空白对照组（P＜0.05），参考对照组患者感染发生率显著低于空白对照组（P＜0.05）。干预组和参考对照组患者高血糖、高血脂发生率均显著低于空白对照组（P＜0.05）。三组患者移植术后生存率和排斥反应发生率比较差异均无显著性（P＞0.05）。结论心脏移植术后早期停用皮质类固醇激素并不会显著增加排斥反应的发生，但能明显减少感染、高血糖等并发症的发生，联合使用复方磺胺甲唑能有效预防心脏移植术后感染并发症的发生，是一种安全有效且经济实惠的预防手段。
목적：탐토복방광알갑서화피질류고순격소대심장이식술후감염병발증적영향。방법선취본원2011년1월지2013년3월실시동충이체원위심장이식62례환자위연구대상，62례환자중6례실방，기여56례환자분위공백대조조（23례）、삼고대조조（14례）화간예조（19례）。삼조환자균채취상동적면역억제방안（타극막사＋매분산지＋피질류고순격소）。공백대조조환자보지면역억제방안불변，불진행기타간예；삼고대조조환자술후3개월내정용피질류고순격소；간예조환자술후3개월내정용피질류고순격소，동시구복복방광알갑서。술후균수방6～24개월，평고삼조환자심장이식술후생존솔、이식심장배척반응발생솔이급감염、고혈지、고혈당등병발증발생솔。결과간예조환자감염발생솔현저저우삼고대조조화공백대조조（P＜0.05），삼고대조조환자감염발생솔현저저우공백대조조（P＜0.05）。간예조화삼고대조조환자고혈당、고혈지발생솔균현저저우공백대조조（P＜0.05）。삼조환자이식술후생존솔화배척반응발생솔비교차이균무현저성（P＞0.05）。결론심장이식술후조기정용피질류고순격소병불회현저증가배척반응적발생，단능명현감소감염、고혈당등병발증적발생，연합사용복방광알갑서능유효예방심장이식술후감염병발증적발생，시일충안전유효차경제실혜적예방수단。
ObjectiveTo explore influences of compound sulfamethoxazole and corticosteroid on complications after heart transplantation.Method62 patients underwent orthotopic allograft heart transplantation implemented in our hospital from January 2011 to March 2013 were selected as objects of study. 6 patients out of 62 patients lost follow up, remained 56 patients were divided into blank control group (23 patients), reference control group (14 patients) and intervention group (19 patients). Three groups of patients adopted the same immunosuppression solution (tacrolimus+mycophenolate mofetil+corticosteroid hormone). Patients in blank control group were treated with immunosuppression plan unchanged without other interventions. Patients in reference control group discontinued taking corticosteroids within 3 months after operations. Patients in ntervention group discontinued taking corticosteroids within 3 months after operations and orally took compound sulfamethoxazole. 6~24 months of postoperative follow-up were made after operation, the heart transplantation survival rate, incidence of rejection reaction, and incidences of complications including infection, hyperlipemia and hyperglycemia of patients were compared between the three groups.ResultThe incidence of infections in intervention group was signiifcantly lower than blank control group and reference control group (P<0.05), the incidence of infections in reference control group was signiifcantly lower than blank control group (P<0.05). The incidence of hyperglycemia, hyperlipemia in intervention group and reference control group were signiifcantly lower than blank control group (P<0.05). The comparison differences in survival rates and incidences of rejection reaction between the three groups were not signiifcant (P>0.05).ConclusionEarly discontinuation corticosteroids after heart transplantation will not signiifcantly increase the incidence of rejection reaction, but it can obviously reduce the incidence of complications including the infection, rejection reaction, and combined with compound sulfamethoxazole can effectively prevent the incidence of infection after heart transplantation, being a safe, effective and economical means of prevention.