多器官联合移植的免疫抑制治疗

目的　探讨多器官联合移植术后的免疫抑制治疗方法。方法　对 2例 1型糖尿病并发尿毒症患者施行改良式胰液肠腔引流式胰、十二指肠及肾一期联合移植 ;1例高龄酒精性肝硬化终末期并发慢性肾功能不全尿毒症患者和 1例肝硬化肝功能衰竭肝移植术后移植肝、肾功能衰竭患者施行一期肝肾联合移植 ;1例慢性乙型病毒性肝炎、肝硬化、原发性肝细胞肝癌合并胰岛素依赖型糖尿病患者施行同期原位肝 -异位胰十二指肠联合移植术。术后采用抗胸腺淋巴细胞球蛋白 (ATG)、抗CD2 5单克隆抗体诱导 ,他克莫司 (FK5 0 6 )、霉酚酸酯 (MMF)及激素三联维持治疗。结果　 5例患者术后移植物功能恢复良好 ,其中 1例胰肾联合移植患者术后出现 1次FK5 0 6导致的肾中毒 ,1例肝肾联合移植患者和肝胰联合移植患者术后发生 1次急性排斥反应 ,分别经调整药物剂量和抗排斥治疗后逆转。目前 5例患者全部存活 ,移植物功能正常。结论　多器官联合移植术后采用ATG、抗CD2 5单克隆抗体诱导 ,FK5 0 6、MMF及激素三联维持治疗是安全有效的 ,用药期间应监测移植物功能和FK5 0 6的血药浓度 ,防止排斥反应和FK5 0 6中毒。     

心脏移植术后的免疫抑制治疗

目的:探讨原位心脏移植术后免疫抑制经验. 方法:2000-01/2003-10施行26例原位心脏移植手术,术后17例采用他克莫司(FK506)、霉酚酸酯(MMF)及泼尼松组成的三联疗法进行免疫抑制治疗,9例采用环孢素-A(CsA)、霉酚酸酯(MMF)及泼尼松三联疗法进行免疫抑制治疗. 结果:死亡3例,存活23例,生活质量良好,其中6例发生了11次急性排异反应,经冲击治疗后逆转. 但同时出现一些药物副作用,如肾功能损害、高血压、高血糖等. 结论 :心脏移植术后采用FK506, MMF及泼尼松新三联或CsA、MMF及泼尼松三联免疫抑制治疗效果良好,但要严密观察药物的毒副作用.     

Immunosuppressive therapy in autoimmune disease — A review

The above is by no means intended to be a comprehensive compendium of all currently available immunosuppressive therapies, but rather is designed to provide guidelines regarding some of the newer therapeutic options open to the clinician when faced with a patient with signs of a progressive and potentially destructive autoimmune process. It is worth noting that we are entering a period of rapid development with regard to our knowledge of the pathogenesis and underlying mechanisms of disease and one could envisage eventually categorizing autoimmune disease in terms of a specific immunological aberration and then administering an agent with selective action to correct the critical deficiency or imbalance. This goal may prove naive or unrealistic.     

肝移植2例的免疫抑制疗法

目的：探讨肝移植术后的免疫抑制疗法。方法：国内首例活体肝移植和首例辅助性活体肝移植患者分别采用环孢素A和FK506作为主要免疫抑制剂成功实施了两类术式的免疫调控。结果：例1供受体为父女关系，术后采用环孢素A联合硫唑嘌呤，皮质激素行免疫抑制治疗，术后3mo停用硫唑嘌呤，5mo停用激素改用酶酚酸酯，手术1a后环孢素A血药浓度控制在50－100μg.L^-1，患者已健康生存41mo；例2供受体血型不同，供体为A型血，受体为O型血，围手术期采用环磷酰胺，FK506、皮质激素联合免疫抑制治疗，手术前8d开始使用环磷酰胺，术后1mo停用，术后5mo停用皮质激素改用酶酚酸酯，现FK506血药浓度维持在10－15μg.L^-1，目前患者已健康生存6mo。结论：肝移植术后需要据患者的具体情况采用个体化的免疫抑制疗法，无论环孢素A还是FK506均有较好的疗效。术后0.5a内停用皮质激素是安全的。     

Immunosuppressive therapy in lung injury due to paraquat poisoning: a meta-analysis

INTRODUCTION: Immunosuppressive therapy has been shown to improve outcomes in patients with paraquat poisoning. The objective of this study was to evaluate the efficacy of immunosuppressive therapy in the management of lung injury due to paraquat poisoning. METHODS: We searched the MEDLINE, OVID, and CINAHL databases for relevant studies published from 1980 to 2006. We included studies if (a) the study design was a randomised controlled trial, observational study with historical controls or observational study; (b) the study population included patients with paraquat poisoning, and received immunosuppressive therapy; and (c) the study provided data on mortality. We calculated the survival rate with 95 percent confidence intervals (CI) for observational studies, and relative risk and 95 percent CI for dichotomous outcomes. RESULTS: 12 studies--four non-randomised, six non-randomised comparing historical controls, and two randomised controlled trials--had employed immunosuppressive therapy in the management of paraquat poisoning. The survival rate in the four non-randomised studies (39 patients) was 74.4 percent (95 percent CI 58.9-85.4). The relative risk of immunosuppressive therapy in decreasing mortality with paraquat poisoning was 0.55 (95 percent CI 0.39-0.77) and 0.6 (95 percent CI 0.27-1.34) for the non-randomised studies (comparing historical controls) and randomised controlled studies, respectively. There was significant heterogeneity and evidence of publication bias. CONCLUSION: One out of four patients (95 percent CI 3-5) were successfully treated with immunosuppressive therapy for paraquat poisoning. However, due to significant heterogeneity and publication bias, a large randomised controlled trial will be required to affirm the role of immunosuppression in paraquat poisoning.     

Dialysis therapy in children

Acute dialysis can be life saving for children suffering from acute emergencies due to acute renal failure, poisoning or inborn errors of metabolism causing severe organic acidaemia and hyperammonaemia. Chronic dialysis is life sustaining for children with chronic renal failure or end stage renal disease till renal transplantation is performed. The basic principles, indications, procedures, equipment, complications of acute and chronic dialysis in children are same as in adults. Dialysis can be performed in children at any age from newborn to adolescent period. In newborn, infants and preschool children (0-5 years age) haemodialysis is difficult due to technical problems associated with vascular access and haemodynamic instability. Peritoneal dialysis is simple, efficient, easy to perform, does not require highly sophisticated equipment or personnel and with low complication rate. For successful dialysis appropriate sizes of catheters, tubings, dialysers, small volume dialysate bags, etc, are required. These are now available in our country, although the cost of peritoneal dialysis fluid and catheters, etc, is 2-3 times higher than equipment for haemodialysis. Hence, continuous ambulatory peritoneal dialysis for chronic renal failure/end stage renal disease has not taken off yet in India. A team of experts including specially trained paediatric nephrologists, urologists, nurses, dieticians, technicians and social workers are needed to organise dialysis programme for children with end stage renal disease. Acute peritoneal dialysis should be made available in each paediatric department offering emergency services to children.     

联合霉酚酸酯、环孢素A和泼尼松应用于肾移植患者免疫抑制治疗

目的研究不同剂量霉酚酸酯（MMF）与环孢素A（CsA）和泼尼松（Pred）联用对肾移植患者免疫抑制作用的疗效与安全性。方法随机将120例肾移植受者分为3组，分别给予MMF2．0g／d（A组）、1.5g／a（B组）及硫唑嘌呤（Aza）100mg／d（C组）。3组患者均同时接受相似剂量的CsA和Pred。观察肾移植术后6个月内急性排斥反应的发生率、移植肾功能和药物的副作用。结果A，B，C组急性排斥反应的发生率分别为8．7％，5．6％和36．8％；A，B组消化道的副作用多见，C组的白细胞减少现象多见，其他副作用3个组的差异无显著性。术后6个月A，B组患者的血清肌酐值明显低于C组。结论不同剂量的MMF与CsA和Pred联合应用，可有效预防术后早期急性排斥反应的发生。MMF除胃肠道的副作用较多外，其他副作用未见增多。     

电化学法治疗小儿血管瘤疗效分析(附157例报告)

目的探讨电化学(electreacal chemical therapy,ECT)治疗小儿血管瘤的方法、适应证及疗效.方法对近5年在我院应用电化学方法治疗的157例小儿血管瘤和其中112例治疗后6个月～3年的随访资料进行回顾分析.结果治愈60例(53.7%),部分治愈36例(32.1%),无效16例(14.3%).本组总有效率为85.7%.结论ECT为小儿血管瘤治疗的新方法,具有操作简便、相对安全、创伤较小、痛苦小、疗效较好和治疗次数少等优点,主要适用于海绵状及混合型血管瘤的治疗.     

儿童功能性便秘生物反馈治疗研究进展

功能性便秘(functional constipation,FC)是指非全身疾病或肠道疾病所引起的原发性持续便秘,又称为习惯性便秘或单纯性便秘,是儿童排便障碍的常见原因。FC占儿童便秘的90%以上。生物反馈是一种新兴的行为疗法,被广泛用于成人FC患者的治疗,具有较好的效果。然而,其在治疗儿童便秘患者的疗效还存在一定的争议。文中就儿童FC生物反馈治疗的研究进展作一综述。