摘要
目的探讨肝移植术后应用不含皮质激素的免疫抑制方案对受者糖代谢的影响。方法回顾分析295例首次接受成人肝移植，且术后规律随访超过6个月受者的临床资料，将受者分研究组（153例）和对照组（142例），研究组受者采用他克莫司（Tac）＋吗替麦考酚酯（MMF）的免疫抑制方案，对照组受者采用Tac＋MMF＋皮质激素方案。分别于术前1周及术后第1、2、4、8、12、16、20和24周为观察时间点，检测两组受者的血糖水平变化，观察急性排斥反应及高血糖相关不良事件的发生情况。结果两组间受者性别、年龄、体重等基本资料，尤其是术前空腹血糖水平和高血糖患者比例的差异均无统计学意义（P〉0．05）。两组受者术后早期血糖水平均显著升高，术后1周时达到峰值，并随术后时间的延长呈逐渐下降的趋势。各时间点研究组的受者空腹血糖水平及高血糖患者比例均低于对照组，术后4周以后，与对照组比较，差异均有统计学意义（P〈0．05）。研究组和对照组高血糖者的比例分别为52．9％和76．8％（P〈0．05），对照组术后发生高血糖的风险是研究组的2．94倍。随访期间，研究组和对照组的急性排斥反应发生率分别为8．50％（13／153）和7．75％（11／142），两组比较，差异无统计学意义（P〉0．05）。研究组受者出现组织愈合延迟、感染及高脂血症发生率亦低于对照组。结论肝移植术后应用不含皮质激素的免疫抑制方案是安全的，并可降低术后发生糖尿病的风险，减少高血糖相关不良事件的发生率。
Objective To discuss the impact of a immunosuppressive protocol using tacrolimus combined with mycophenolate without steroid on glycometabolism after liver tansplantation （LT）. Methods 295 adult liver transplant recipients were under investigation and divided into two groups, to receive immunosuppression therapy using tacrolimus and mycophenolate with （n = 142） or without steroid （n = 153）. The fasting blood-glucose level, rate of hyperglycemia, infection and metabolic complications were followed up at 1st, 2nd, 4th, 8th, 12th, 16th, 20th and 24th week after LT. Results There were no significant differences between two groups in gender, age, body weight and FBG level before LT. In both groups, the FBG levels were significantly elevated immediately and reached the peak at 1 st week after I.T, then gradually decreased over time post-LT. The FBG level and rate of hyperglycemia were significantly lower in steroicl free group than in steroid group in each observation time point with the differences being significant （P〈0. 05） at 4th week post-LT. The overall rate of hyperglycemia was 52.9% in steroid-free group and 76. 8% in steroid group with the difference being significant between the two groups （P〈0. 05 ） and a risk ratio of 2. 94 （steroid-free group versus steroid group）. The rate of acute rejection was slightly higher in steroid-free group （8. 50%） than in steroid group （7.75%） （P〉0.05）. Also the incidence of intention badness, infection and hypercholesterinemia was significantly lower in steroid group than in steroid free group. Conclusion The immunosuppressive protocol without steroids is safe and effective of reducing the risk of hyperglycemia and metabolic complications after LT.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2012年第6期347-350,共4页
Chinese Journal of Organ Transplantation
关键词
肝移植
免疫抑制法
糖皮质激素类
血糖
Liver transplantation
Immunosuppression
Glucocorticoids
Blood glucose
