他克莫司滴眼液预防高危角膜移植免疫排斥反应的研究

The immunosuppressive activity of tacrolimus eye drops in high-risk corneal transplantation

目的观察他克莫司滴眼液预防高危角膜移植免疫排斥反应的效果。方法回顾性研究。选取山东省眼科医院2013年至2015年间成功施行角膜移植术的高危免疫排斥患者48例(50只眼),根据术后局部免疫抑制剂使用种类,分为他克莫司组23例(25只眼)和环孢素组25例(25只眼)。术前对所有患者进行排斥风险评分,以排斥反应指数(RI)判断是否出现植片免疫排斥反应,当RI≥5时视为发生免疫排斥反应,所有患者术后随访1年,对比1年内患者术后植片免疫排斥发生率。结果两组各25只眼,排斥风险评分他克莫司组与环孢素组不具有统计学差异(t=0.65,P=0.52>0.05)。术后1年内免疫排斥发生率,环孢素组10例(10只眼)发生排斥,免疫排斥发生率为40.00%,他克莫司组3例(3只眼)发生排斥,免疫排斥发生率为12.00%,他克莫司组免疫排斥率明显低于环孢素组,差异具有显著性(χ~2=5.09,P<0.05)。结论他克莫司滴眼液对高危角膜移植免疫排斥反应有较好的预防和治疗作用。

Objective To assess the immunosuppressive activity of 0. 1% tacrolimus eye drops in high-risk corneal transplantation. Methods A retrospective study. 48 patients who received successful high-risk corneal transplantation in Shandong Eye Hospital were selected from 2013 to 2015. They were divided into tacrolimus group（ 23 patients,25eyes） and cyclosporine（ 25 patients,25 eyes）. All patients were scored for rejection risk before surgery. We used rejection index（ RI） to determine whether the immune rejection had occurred. We considered immune rejection occurred when RI≥5. All patients were followed up for 1 year. We compared rate of rejection. Results The pre-operative rejection risk score was not statistically different between tacrolimus group and cyclosporine group（ t = 0. 65,P = 0. 52）. 10 patients（ 10 eyes） in cyclosporine group developed immune rejection（ rate 40.0%）. 3 patients（ 3 eyes） in tacrolimus group developed immune rejection（ rate 12. 0%）. The rejection rate was significantly lower in tacrolimus group than in cyclosporine group（ χ2= 5. 09,P〈0.05）. Conclusions Topical application of 0.1% tacrolimus eye drops suppressed graft rejection in high risk corneal transplantation.