他克莫司对真菌性角膜炎患者移植手术后免疫排斥的影响

Effect of tacrolimus on immunological rejection after transplantation in patients with fungal keratitis

目的探究他克莫司对真菌性角膜炎患者移植手术后免疫排斥的影响,为临床治疗真菌性角膜炎提供参考。方法回顾性分析2010年3月-2017年2月医院收治的真菌性角膜炎行治疗性穿透性角膜移植术后的患者56例(57眼)。根据术后采用治疗方式的不同将患者分为对照组23例(23眼)和试验组33例(34眼),所有患者经确诊后在术前给予常规抗真菌抗炎治疗,主要药物有:氟康唑滴眼液、左氧氟沙星滴眼液、氧氟沙星眼膏,手术前后总疗程小于2周,并注重观察患者的生命体征。行手术去除位于病变角膜表面发生坏死的组织及菌丝苔被,完成手术后采用抗真菌药物治疗,给予对照组患者环孢素A滴眼液进行治疗,试验组患者给予他克莫司滴眼液进行治疗,至末次随访,患者仍继续采用低浓度糖皮质激素进行治疗。一个月后观察手术后治疗效果、免疫排斥反应发生状况、其他并发症等情况。结果两组患者共培养分离真菌43株,主要为镰刀菌、曲霉菌属、链格孢霉属、假丝酵母,其中镰刀菌24株占55.81%;曲霉菌属14株占32.56%。治疗一个月后,两组疗效差异无统计学意义,临床有意义。治疗1个月后,试验组患者免疫排斥反应5例低于对照组10例(P<0.05);两组患者的最佳矫正视力,差异无统计学意义。在患者住院期间及随访期间,两组患者均未发生相应的并发症。结论他克莫司能有效抑制患者术后免疫排斥,效果较好,安全性较高。

OBJECTIVE To investigate the effect of tacrolimus on immunological rejection after fungal keratitis in patients with fungal keratitis,so as to provide references for clinical treatment of fungal keratitis.METHODS A total of 56 cases（57 eyes）of patients with fungal keratitis in the treatment of penetrating keratoplasty from Mar.2010 to Feb.2017 were retrospectively analyzed.According to the different treatment methods after treatment,the patients were divided into control group of 23 cases（23 eyes）and experimental group of 33 cases（34 eyes）,and all patients were given conventional anti-fungal anti-inflammatory treatment before the operation,the main drugs were：fluconazole eye drops,levofloxacin eye drops fluid and ofloxacin ointment.The total course of treatment before and after surgery was less than 2 weeks,and we paid attention to observe the patient′s vital signs.The tissue and mycelial moss of necrosis on the surface of the lesion＇s cornea were removed by operation,and then the patients were treated with antifungal agents after the operation.The patients in control group were treated with cyclosporine A eye drops,and in experimental group were treated with tacrolimus fluid to the last follow-up,and patients still continued to use low concentrations of glucocorticoid for treatment.The effect of postoperative treatment,immune rejection,other complications and other data were observed at 1 month after the operation.RESULTS Totally 43 strains of fungi were cultured and isolated in the two groups of patients,which were mainly Fusarium,Aspergillus,Alternaria,and Candida.Among which,Fusarium were 24 strains,accounting for55.81%,and Aspergillus were 14 strains,accounting for 32.56%.After a month of treatment,there was no significant difference in the effective rate between the two groups.In experimental group,the number of cases of immunological rejection was 5 cases,which was lower than 10 cases in control group（P〈0.05）.The best corrected visual acuity between the two groups had no significant difference.During the hospital stay and follow-up period,the two groups of patients did not occur the corresponding complications.CONCLUSIONTacrolimus can effectively inhibit the postoperative immune rejection,the effect is significant and the safety was high.