同种异体原位心脏移植受者疗效分析

doi:10.6040/j.issn.1671-7554.0.2014.353

摘要/Abstract

摘要： 目的探讨分析原位心脏移植术治疗终末期心脏病的疗效。方法回顾性分析同种异体原位心脏移植受者40例的临床资料。其中扩张型心肌病29例、缺血性心肌病6例、肥厚型心肌病4例和限制性心肌病1例。免疫抑制治疗采用环孢素+糖皮质激素+吗替麦考酚酯三联方案,35例受者给予抗Tac单克隆抗体或巴利昔单克隆抗体的诱导治疗。根据血药谷浓度(C0)与峰浓度(C2)调整环孢素的使用。结果术后1个月存活率95%(38/40)。1、3、5年生存率分别为90%、82.5%、77.5%。受体主要死亡原因包括右心衰竭、真菌感染及移植物衰竭。出现急性排斥反应7例,经激素冲击治疗后均逆转,排斥反应发生率17.5%。采用环孢素血药浓度C0、C2同时监测后发生排斥反应3例,发生率15%。结论心脏移植术治疗各种终末期心脏病疗效确实可靠,C0、C2同时监测可控制环孢素浓度在有效的范围内,避免早期急性排斥反应的发生。

关键词: 终末期心脏病, 环孢素浓度, 感染, 心脏移植, 免疫抑制治疗

Abstract: Objective To summarize and analyze the clinical efficacy and experiences of orthotopic cardiac transplantation for end-stage heart disease. Methods Data of 40 patients underdoing orthotopic heart transplantation in our center in the past 10 years were retrospectively reviewed. The enrollments included 29 cases of dilated cardiomyopathy, 6 cases of ischemic heart disease, 4 cases of hypertrophic cardiomyopathy, and 1 case of restrictive cardiomyopathy. Immunosuppressive therapy with cyclosporine A, corticosteroid, and mycophenolate mofetile was adopted. Thirty-five patients received induction therapy with Tac monoclonal antibody or basiliximab monoclonal antibody. According to trough concentration (C0) and peak concentration (C2), the dose of cyclosporine A was regulated. Results The rate of successful operation was 95% (38/40). The 1-, 3-, 5- year survival rate was 90%, 82.5%, and 77.5%. Main causes of death were right heart failure, fungal infection, and graft failure. Acute rejection occurred in 7 cases (17.5%), and all recovered after cortieasteriod impulse therapy. Three cases were diagnosed as rejection after C0 and C2 were monitored spontaneously. Conclusion It's reliable to treat patients with end-stage heart disease with orthotopic cardiac transplantation. Monitoring C0 and C2 can control the cyclosporine concentration within the valid range and avoid occurrence of early acute rejection.

Key words: Infection, Heart transplantation, Immunosuppressive therapy, Cyclosporine concentration, End-stage heart disease

中图分类号:

R654.2

王砚池, 刘天起, 王东, 厉泉, 李培杰, 毕严斌, 李敏, 许莉, 马延平, 王明华. 同种异体原位心脏移植受者疗效分析[J]. 山东大学学报（医学版）, 2014, 52(12): 60-63.

WANG Yanchi, LIU Tianqi, WANG Dong, LI Quan, LI Peijie, BI Yanbin, LI Min, XU Li, MA Yanping, WANG Minghua. Clinical efficacy of orthotopic heart transplantation for 40 patients[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(12): 60-63.

参考文献

[1] 张世泽, 周思伯, 方立德, 等. 原位心脏移植一例报告[J]. 上海医学, 1978, 10: 625-627. ZHANG S Z, ZHOU S B, FANG L D, et al. The report of 1 orthotopic heart transplantation [J]. Shanghai Medical Journal, 1978, 10:625-627.
[2] 王东, 王春祥. 同种异体原位心脏移植术(附1例报告)[J]. 山东医药, 2004, 44(2): 28-30. WANG D, WANG C X. orthotopic heart transplantations (1 case report) [J]. Shandong Medical Journal, 2004, 44(2): 28-30.
[3] 刘天起, 王东, 刘培杰, 等. 原位心脏移植治疗终末期心脏病25例临床分析[J]. 中华移植杂志: 电子版, 2013, 7(1): 10-13. LIU T Q, WANG D, LI P J, et al. Analysis on 25 cases of orthotopic cardiac transplantation for end-stage heart disease [J]. J Cardiovasc Med: Hagerstown, 2013, 7(1):10-13.
[4] Costanzo M R, Dipchand A, Starling R, et al. The international society of heart and lung transplantation guidelines for the care of heart transplant recipients[J]. J Heart Lung Transplant, 2010, 29(8):914-956.
[5] 杨守国, 王春生, 陈昊, 等. 298 例原位心脏移植受者远期疗效分析[J]. 中华移植杂志: 电子版, 2011, 5(2):101-105. YANG S G, WANG C S, CHEN H, et al. Long-term results of 298 cases of orthotopic heart transplantation: a single center experience [J]. J Cardiovasc Med (Hagerstown), 2011, 5(2):101-105.
[6] Schaffer J M, Chiu P, Singh S K, et al. Heart and combined heart-kidney transplantation in patients with concomitant renal insufficiency and end-stage heart failure [J]. Am J Transplant, 2014, 14(2): 384-396.
[7] Russo M J, Chen J M, Sorabella R A, et al. The effect of ischemic time on survival after heart transplantation varies by donor age: an analysis of the United Network for Organ Sharing database [J]. J Thorac Cardiovasc Surg, 2007, 133(2): 554-559.
[8] John R, Rajasinghe H A, Chen J M, et al. Long-term outcomes after cardiac transplantation: an experience based on different eras of immunosuppressive therapy [J]. Ann Thorac Surg, 2001, 72(2): 440-449.
[9] Rosenberg P B, Vriesendorp A E, Drazner M H, et al. Induction therapy with basiliximab allows delayed initiation of cyclosporine and preserves renal function after cardiac transplantation[J]. J Heart Lung Transplant, 2005, 24(9): 1327-1331.
[10] Aliabadi A, Grömmer M, Zuckermann A. Is induction therapy still needed in heart transplantation?[J]. Curr Opin Organ Transplant, 2011, 16(5): 536-542.
[11] Billingham M E, Cary N R, Hammond M E, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group. The International Society for Heart Transplantation[J]. J Heart Transplant, 1990, 9(6):587.
[12] Stewart S, Winters G L, Fishbein M C, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection[J]. J Heart Lung Transplant, 2005, 24(11): 1710-1720.
[13] Barnard J B, Thekkudan J, Richardson S, et al. Cyclosporine profiling with C2 and C0 monitoring improves outcomes after heart transplantation [J]. J Heart Lung Transplant, 2006, 25(5): 564-568.
[14] Knight S R, Morris P J. The clinical benefits of cyclosporine C2-level monitoring: a systematic review [J]. Transplantation, 2007, 83(12): 1525-1535.
[15] Solari S G, Goldberg L R, DeNofrio D, et al. Cyclosporine monitoring with 2-hour postdose levels in heart transplant recipients[J]. Ther Drug Monit, 2005, 27(4): 417-421.
[16] Puehler T, Goepel L, v Tschirschnitz M, et al. C2 therapeutic drug monitoring of cyclosporine is a safe and feasible method in de novo heart transplant patients[J]. Transplant Proc, 2007, 39(10):3329-3333.
[17] Hermann M, Enseleit F, Fisler A E, et al. Cyclosporine C0-versus C2-monitoring over three years in maintenance heart transplantation [J]. Swiss Med Wkly, 2011, 141(3): 13149.

相关文章 15

[1]	赵文博,甄长青,袁代,单宁宁,王娜,封丽丽,李沛沛,丁梅,李英,张凌岩,王欣. 膦甲酸钠治疗血液病患者合并EB病毒感染的临床疗效[J]. 山东大学学报（医学版）, 2017, 55(9): 96-99.
[2]	于珍珍,陈慧,杨晓云,吕明. 高尿酸血症、幽门螺杆菌感染与代谢综合征的相关性[J]. 山东大学学报（医学版）, 2017, 55(5): 76-80.
[3]	王成,刘庆华,赵娜,姚周虹,万云焱,林殿杰. 内科胸腔镜诊治曲菌性脓胸2例[J]. 山东大学学报（医学版）, 2017, 55(4): 107-110.
[4]	高萌,孙建民,蒋振松,崔新刚. MRI在布氏杆菌脊柱炎诊断中的应用价值[J]. 山东大学学报（医学版）, 2016, 54(6): 27-30.
[5]	盖林林,管立学,李海波,褚锦锦,朱芸,李明. 免疫性疾病患者T-SPOT.TB筛查结果及影响因素[J]. 山东大学学报（医学版）, 2016, 54(6): 82-86.
[6]	胡连龙,宋光民,赵鑫,白霄,张健,赵廷蕾,王龙. CCL25/CCR9在大鼠心脏移植慢性排斥反应中的表达及意义[J]. 山东大学学报（医学版）, 2016, 54(2): 1-5.
[7]	李倩,戴桃李,韩炜,郭成浩. 血管内皮细胞活化在感染后肠易激综合征发病机制中的作用[J]. 山东大学学报（医学版）, 2016, 54(12): 58-61.
[8]	姚月,张捷. 鼻型结外NK/T细胞淋巴瘤合并肺部感染1例[J]. 山东大学学报（医学版）, 2016, 54(11): 87-89.
[9]	王浩, 张娜, 薛付忠, 王萍, 康殿民, 刘言训. 山东省艾滋病病毒感染者及艾滋病患者空间流行特征[J]. 山东大学学报（医学版）, 2015, 53(2): 81-86.
[10]	李晨, 程玉峰, 李爱禄. 妇科门诊女性人乳头瘤病毒感染型别分布特征及临床分析[J]. 山东大学学报（医学版）, 2015, 53(11): 73-76.
[11]	康秀华, 邱云, 何海燕, 陈宏碧, 阳秀英. ICU医务人员手卫生质量不合格原因分析及对策[J]. 山东大学学报（医学版）, 2014, 52(Z2): 179-180.
[12]	许月芳, 刘皈阳, 张鑫. 氨曲南治疗下呼吸道感染疗效及安全性的Meta分析[J]. 山东大学学报（医学版）, 2014, 52(Z2): 198-200.
[13]	周朋哲. 十二指肠镜引导下十二指肠胆汁引流术在重型肝炎伴胆道感染中的应用[J]. 山东大学学报（医学版）, 2014, 52(Z1): 152-153.
[14]	韩娟, 刘凤琴, 程瑞霞, 韩学波. 医院感染与消毒效果时机调查分析[J]. 山东大学学报（医学版）, 2014, 52(Z1): 216-216.
[15]	何昶江. 普外科手术切口感染因素探讨[J]. 山东大学学报（医学版）, 2014, 52(S2): 23-23.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed