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.

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