我国2004～2006年免疫抑制剂市场状况分析

目的:为临床合理、安全应用免疫抑制剂提供参考。方法:收集《全国医药经济信息网》中有关免疫抑制剂销售数量和销售金额的数据,并参考国内、外文献,进行对比分析。结果与结论:2004~2006年销售数量和销售金额最多排序列前3名的品种为霉酚酸酯、环孢霉素、他克莫司;而他克莫司有望成为器官移植的首选治疗药物。     

肾移植术后应用新型免疫抑制剂受者肺部感染的临床研究

目的 探讨肾移植术后应用新型免疫抑制剂受者肺部感染的发病率、发病原因及治疗效果.方法 对我院752例肾移植术后受者的临床资料进行回顾性分析.752例病人中分为3组,应用环孢素A、骁悉、强的松治疗226例为环孢素A组,应用FK506、骁悉、强的松治疗386例为FK506组,应用FK506、雷帕霉素(Rap)、强的松治疗140例为雷帕霉素组;观察3组肺部感染发病率、死亡率的差异,分析肺部感染的原因、诊断和治疗.结果 752例病人中发生肺部感染53例,治愈50例,死亡3例.环孢素A组肺部感染发病率为7.08/226),死亡1例;FK506组发病率为7.25%(28/386),死亡2例;Rap组发病率为6.43%(9/140),无死亡病例.53例病人中混合感染者17例,单纯细菌感染24例,巨细胞病毒感染9例,真菌感染1例,病原菌不明2例;检出的细菌中G(革兰氏阴性)细菌占68.35%.结论 G菌是肾移植术后肺部感染的常见病原菌,术后前6个月是肺部感染的高危时段.环孢素A组、FK506组、雷帕霉索组肺部感染的发生率差异无显著性.肾移植术后重视围手术期呼吸道管理、避免排斥反应发生和生物制剂的应用.是预防肺部感染的主要手段;早发现、早治疗,是减少重症肺炎死亡率提高人肾存活率的关键.＃     

Neurotoxicity of calcineurin inhibitors: impact and clinical management

Between 10 %–28 % of patients who receive the immunosuppressant cyclosporine (CsA) experience some form of neurotoxic adverse event. Both sensorial motoric functions may be adversely affected, and thus patients present with a wide range of neurological and psychiatrical disorders. Mild symptoms are common and include tremor, neuralgia, and peripheral neuropathy. Severe symptoms affect up to 5 % of patients and include psychoses, hallucinations, blindness, seizures, cerebellar ataxia, motoric weakness, or leukoencephalopathy. Tacrolimus is associated with similar neurotoxic adverse events. Neurotoxicity may result in serious complications for some patients, particularly recipients of orthotopic liver transplants. Factors that may promote the development of serious complications include advanced liver failure, hypertension, hypocholesterolemia, elevated CsA or tacrolimus blood levels, hypomagnesemia, and methylprednisolone. Occipital white matter appears to be uniquely susceptible to the neurotoxic effects of CsA; injury to both the major and minor vasculature may cause hypoperfusion or ischemia and local secondary toxicity in the white matter. Calcineurin inhibition by CsA and tacrolimus alters sympathetic outflow, which may play a role in the mediation of neurotoxic and hypertensive adverse events. The symptoms of CsA- and tacrolimus-associated neurotoxicity may be reversed in most patients by substantially reducing the dosage of immunosuppressant or discontinuing these drugs. However, some patients have experienced permanent or even fatal neurological damage even after dose reduction or discontinuation. CsA-sparing and tacrolimus-sparing drug regimens that use the immunosuppressant mycophenolate mofetil, which has no neurotoxic effects, may reduce the incidence and severity of neurotoxic adverse events while maintaining an adequate level of immunoisuppression. Received: 6 April 1999/Revised: 19 April 2000/Accepted: 5 June 2000     

吻合血管同种异体肱骨干移植20年随访结果

目的 回顾总结吻合血管同种异体肱骨干移植的临床效果。并评价其临床意义。方法 1979年9月-11月,采用吻合血管的同种异体肱骨干移植修复1例肱骨干10cm缺损,2例胫骨干12cm缺损,术后使用硫唑嘌呤,强地松等免疫抑制剂3个月,进行连续20年随访。结果 例1修复肱骨干骨折术后恢复顺利,骨愈合,重塑良好,能胜任原工作,例2术后3年内发生5次慢性排斥反应。经治疗好转;术后2年发生移植骨骨折,经取自体髂骨植骨愈合,能胜任原工作,例3术后3年10个月发生骨折,取自体髂骨植骨愈合;术后20年随访,移植骨中段不愈合,仍能从事农业劳动,结论 用现代移植免疫学原理,进行良好的组织配型,在一段时间内使用有效免疫抑制剂,有可能提高同种异体长管状骨移植的临床效果。     

他克莫司治疗肾移植术后耐激素性排斥反应的临床观察

目的观察用他克莫司(FK506)替换环孢素A(CsA)治疗肾移植术后耐激素性排斥反应的效果.方法26例肾移植患者应用CsA后出现排斥反应,经用甲泼尼龙(MP)0.5g/d×3d冲击治疗效果不佳,改用FK506治疗,FK506的浓度维持在8～12μg/L左右,临床症状减轻,免疫及生化指标逐渐好转,为治疗有效.治疗无效者主要改用单克隆抗CD3抗体(OKT3)治疗.结果本组26例耐激素性排斥经改用FK506后,23例分别在8～15d逆转,肾功能恢复正常,治愈率88.46%(23/26).3例治疗效果不佳,使用血浆置换治疗和OKT35mg/d×5d后排斥逆转.26例肾功能全部恢复正常,但有3例出现高血糖.结论FK506治疗耐激素性排斥反应效果好,副作用小.治疗时应掌握诊断标准,注意监测血糖及生化指标.对于PRA高于30%的患者行血浆置换治疗,加用OKT3冲击治疗,可取得满意的效果.经上述治疗效果不佳者应及早切除移植肾,以保证患者的生命安全.     

Protective effect of FK506 in the reperfusion model after short-term occlusion of middle cerebral artery in the rat: Assessment by autoradiography using [125I]PK-11195

Abstract

The protective effect of the immunosuppressant agent FK506 in the regerfusion after short-term occlusion of the middle cerebral artery in the rat model was evaluated using [¹²⁵I]PK-1 1195 autoradiography. FK506 0.5 mg kg^-1 day^-1 was administered intramurally to Wistar rats weighing 260-300 g from one day prior to ischemia to seven days after ischemia. Reperfusion was performed after 30 or 60 min occlusion. Infarct area was evaluated by [¹²⁵l]PK-l 1195 autoradiography on the seventh day following occlusion. FK506 significantly reduced the infarct area in the caudate nucleus following 30 and 60 min occlusion, but significantly reduced the infarct area in the cortex only following 60 min occlusion. These results suggest that FK506 has a protective effect against reperfusion after short-term occlusion of the middle cerebral artery. [Neurol Res 2000; 22: 630–633]     

Implant treatment followed by living donor lung transplant: A follow-up case report

PatientsDental implant treatment in patients with complicated systemic disease has been discussed, especially in the context of achieving osseointegration. However, some patients with no pre-existing systemic disease develop it later, during their implant maintenance periods. Organ transplants, and the lifelong administration of immunosuppressants that follows, are also of relevance to post-implant oral health. Thus, strategies to maintain the health of peri-implant tissue in these patients should be considered. Here, we present the case of a patient receiving a living-donor lung transplant during her implant follow-up period. The condition of the lung is affected by that of the oral cavity, so the maintenance is of utmost importance. Throughout the follow-up period, we provided periodical professional maintenance care.Discussion and conclusionThe patient experienced no complications, alterations in her radiographic findings, or worsening of periodontal indices, despite being extensively medicated with immunosuppressants, steroids and bisphosphonate.     

Unsuccessful treatment of four patients with acute graft-vs-host disease after liver transplantation

AIM: To investigate appropriate therapeutic strategies for graft-vs-host disease (GVHD) following liver transplantation.METHODS: Four patients who developed GVHD after liver transplantation in West China Hospital were included in this study. Therapeutic strategies with augmentation or withdrawal of immunosuppressants combined with supportive therapy were investigated in these patients. In addition, a literature review of patients who developed GVHD after liver transplantation was performed.RESULTS: Although a transient response to initial treatment was detected, all four patients died of complications from GVHD: one from sepsis with multiple organ failure, one from gastrointestinal bleeding, and the other two from sepsis with gastrointestinal bleeding. Few consensuses for the treatment of GVHD after liver transplantation have been reached.CONCLUSION: New and effective treatments are required for GVHD after liver transplantation to improve the prognosis of patients with this diagnosis.     

溃疡性结肠炎的治疗现状及前景

溃疡性结肠炎是结、直肠慢性非特异性炎症性疾病,多呈反复发作的慢性病程。本病治疗难度大,与结肠癌的发病有关,被WHO列为现代难治病之一。目前溃疡性结肠炎的治疗手段多样,出现了许多新技术如生物靶向治疗、干细胞移植等,现将近年来溃疡性结肠炎现代医学研究进展进行综述。     

前列地尔治疗反应指导CNI类免疫抑制剂减量的作用

目的探讨前列地尔应用于肾移植术后患者的治疗反应,指导钙调神经蛋白抑制剂（calcineurin inhibitor,CNI）类药物减量的临床应用价值。方法回顾性分析42例同种异体肾移植术后〉1年,肌酐140～250 mmol/L,环孢素或他克莫司血药浓度正常,因肌酐升高于2010年6月至2011年5月在我科住院患者,应用前列地尔治疗效果指导CNI类药物减量,改善移植肾功能的有效率。结果 42例患者经前列地尔治疗后肌酐均有不同程度的下降,其中38例肌酐下降〉20%,平均下降率为23.8%,减少CNI类药物用量后,肌酐稳定出院;2例肌酐分别下降18.7%、14.5%,CNI减药后发生急性排斥反应;2例肌酐分别下降11.9%、16.5%,免疫抑制方案未予调整,停用前列地尔后肌酐稳定出院;前列地尔治疗反应指导CNI类药物减量改善移植肾功能的有效率为95.0%。结论利用前列地尔治疗反应指导CNI类药物减量是一种简便、有效的方法,弥补了血药浓度监测调整CNI类药物用量存在局限性的不足,在临床上有一定的实用价值。