婴儿原位心脏移植术后早期的免疫抑制治疗一例

One case of early immunosuppressive therapy following infant orthotopic cardiac transplantation

目的总结婴儿原位心脏移植术后早期免疫抑制剂应用的临床经验。方法为1例患难治性先天性心脏病的8个月龄婴儿施行原位心脏移植术,术后1个月内应用环孢素A(CsA)、霉酚酸酯(MMF)及泼尼松预防急性排斥反应,1个月后停用泼尼松,仅用CsA和MMF,原则为小剂量用药。术后监测血CsA浓度、白细胞数及T淋巴细胞亚群。定期行超声心动图、心电图及X线胸片检查,结合临床症状与体征综合判断是否发生排斥反应,同时观察药物的不良反应。结果受者顺利渡过围手术期,现已存活260 d,未发生急性排斥反应及感染。术后1个月内血CsA浓度谷值(C_0)维持在0.1664～0.2080μmol/L,2～3个月C_0维持在0.1248～0.1664μmol/L,4～6个月C_0维持在0.0832～0.1248μmol/L,7～10个月C_0维持在0.0666～0.0998μmol/L。未见药物不良反应。结论婴儿原位心脏移植术后早期免疫抑制剂应根据婴儿免疫反应的特点,以口服给药为主、小剂量、不过多干预为原则。

Objective To summarize the clinical experience of early immunosuppressive therapy following infant orthotopic cardiac transplantation. Methods One case of 8 months old infant with in- curable congenital heart disease received orthotropic cardiac transplantation. Cyclosporine A （CsA）, MMF and prednisone were taken in the first month to prevent acute immune infection, and then the prednisone was stopped, CsA and MMF were still administered as hi-associated immunosuppressive therapy. All of the immunosuppressants with low doses were taken blood concentrations of CsA, number of white blood cells and T lymphocyte subsets were monitored postoperatively. Cardiac Doppler ultrasonography, ECG, X-ray examination were done and the clinical symptoms and signs were analyzed for diagnosis of rejection. The side effects of immunosuppressants were observed. Resalts Now the receptor had survived for 260 days and no rejection and infection occurred. The valley value of blood CsA concentration （G0） was kept on 0. 1664-0. 2080 μmol/L in the first month after transplantation, 0. 1248-0. 1664 μmol/L in the next two months, 0. 0832-0. 1248 μmol/L from forth to sixth month, and 0. 0666-0. 0998 μmol/L from seventh to tenth month. There was no drug side effect. Conclusion The early immunosuppressants were orally taken in a low dose in infant orthotopic cardiac transplantation.