免疫抑制剂用于角膜移植排斥反应的临床应用评价

Clinical application of immunosuppressive agents in corneal graft rejection

背景:角膜移植免疫排斥反应是一个复杂的反应过程,一般包括宿主对异体组织抗原的致敏和宿主对异体组织抗原的反应两方面。角膜移植失败的主要原因是免疫排斥反应,有效地防治角膜移植术后免疫排斥反应的发生是眼科治疗中亟待解决的实际问题.目的:文章就目前有关免疫抑制剂在角膜移植免疫排斥反应中的应用作一数据分析。方法:通过计算机检索Scopus数据库中2002/2011有关免疫抑制剂在角膜移植免疫排斥反应中的应用的文献,检索词为"角膜移植(keratoplasty/corneal transplantation);免疫排斥反应(immunological rejection);免疫抑制剂(immunosuppressant);环孢素A(cyclosporine A,CsA);他克莫司(tacrolimus)或FK506;雷帕霉素(rapamycin,RAPA)",共检索文献192篇。结果与结论:免疫排斥反应的发生是多因素参与的复杂过程,尤其高度血管化的角膜、感染性角膜溃疡、重复移植等高危角膜病变,术后出现排斥反应的概率明显增加,排斥反应发生的时间也相对较早,而且时间跨度较长。角膜移植排斥反应是一个复杂的过程,其预防及治疗已取得了多方面的进展,但排斥反应仍是角膜移植失败的首要原因,所以,专家们在不断尝试应用新的药物和治疗措施改善角膜移植的存活率,其最终目标是使受体在保持正常免疫应答能力的情况下,诱导产生/建立供体特异性免疫耐受。免疫抑制剂在角膜移植排斥反应中的应用不可或缺。

BACKGROUND： Immune rejection of corneal transplantation is a complex reaction, typically including leukocyte antigen sensitization and host response to allogeneic tissue antigens. The failure of corneal transplantation is mainly due to immune rejection. Effective prevention of corneal allograft rejection in the eye treatment is a practical problem to be solved. OBJECTIVE： To analyze the application of immunosuppressive agents in corneal graft rejection METHODS： A retrieval was performed for articles addressing the application and effect of immunosuppressive agents in corneal graft rejection, using key words of ＂keratoplasty/corneal transplantation, immunological rejection, immunosuppressant, cyclosporine A, tacrolimus, rapamycin＂ in Scopus database （2002/2011 ）.RESULTS AND CONCLUSION： Immune rejection involves multiple factors. High-risk corneal diseases, such as high-vascularized cornea, infectious corneal ulcer, repeat transplantation, particularly increase the probability of rejection and result in an earlier occurrence of rejections, moreover, the time span is longer after surgery. Corneal transplantation rejection is a complex process, and we have made progress in its prevention and treatment. However, the rejection is still the leading cause of corneal graft failure. The experts are constantly trying to apply the new drugs and treatment measures to improve the corneal graft survival, in order to make the receptor to maintain a normal immune response inducing or establishing donor-specific immune tolerance. Immunosuppressive agents in corneal graft rejection are indispensable. This paper provides a valuable reference for researchers to understand the overview and present situation of this field.