免疫抑制药物在肝移植中的应用现状

背景:现今用于肝移植的抑制免疫排斥反应的药物种类繁多,新型药物也在不断开发中,免疫抑制治疗方案亦多种多样,尚无统一标准。目的:总结和评价肝移植后临床上常用的各型免疫抑制药物并介绍近年来关于免疫抑制治疗方案的热点问题。方法:由第一作者用计算机检索中国全文期刊数据库(CNKI:2000/2011)和PubMed(2000/2011)数据库,检索词分别为"肝移植、免疫抑制、应用、不良反应、撤除"和"Liver transplantation,Immunosuppression,Application,Side-effect,WithdrawaI"。从肝移植后免疫抑制药物的应用现状与进展、免疫抑制方案的选择、激素撤除与免疫抑制剂撤除等方面进行总结。共检索到158篇文献,按纳入和排除标准进行筛选,共纳入45篇。结果与结论:结果表明,目前临床用于肝移植的各种免疫抑制药物都存在着较多不良反应;各种新型、高效、低毒的免疫抑制药物仍在不断研发中,具有广阔前景。激素撤除与免疫抑制剂撤除等新治疗方案的尝试,在一定条件下取得了不错的临床效果,其长期的疗效和安全性有待证实。合理选择和使用免疫抑制药物、开发新型药物、探索新的免疫抑制治疗方案,使肝移植受者的生活质量和生存率得到不断改善。

Application status of immunosuppressive drugs in liver transplantation

BACKGROUND:At present,many types of drugs are used to prevent and treat immune rejection after liver transplantation,the new drugs are developed,and the immunosuppressive regimens are also various.But there are not uniform standards for them until now.OBJECTIVE:To sum and evaluate the immunosuppressants which are used in the clinical treatment after liver transplantation and introduce several hot problems about immunosuppressive treatment in recent years.METHODS:First author searched the literatures from CNKI database(2000/2011) and PubMed database(2000/2011).The keywords were "Liver transplantation,Immunosuppression,Application,Side-effect,WithdrawaI" in Chinese and English.The application and research progress of immunosuppressant after liver transplantation,the choice of immunosuppressive regimens,the research about corticosteroid withdrawal and immunosuppressant withdrawal were summed up.A total of 158 articles were obtained and 45 articles were included accoding to the inclusion and exclusion criteria.RESULTS AND CONCLUSION:The results show that a great variety of immunosuppressive drugs,which have significant side-effects,are used for liver transplantation presently;many new efficient immunodepressant,with low toxicity,are also being developed and had a wide prospect;the research about new immunosuppressive regimens,such as corticosteroid withdrawal and immunosuppressant withdrawal,has achieved some good clinical results under certain conditions,but their long-term efficacy and safety have not been confirmed.The life quality and survival rate of the liver transplanted patients can be greatly improved through the rational selection and use of immunosuppressant,the development of new drugs and exploring new immunosuppressive regimens.