目的探讨合理有效的肝移植术后抗体介导排斥反应(AMR)治疗方案。方法回顾性分析2015年3月至2018年12月天津市第一中心医院成人肝移植术后发生AMR受者和同期肝移植术后发生急性细胞性排斥反应(ACR)受者的临床资料。收集两组受者围手术期...目的探讨合理有效的肝移植术后抗体介导排斥反应(AMR)治疗方案。方法回顾性分析2015年3月至2018年12月天津市第一中心医院成人肝移植术后发生AMR受者和同期肝移植术后发生急性细胞性排斥反应(ACR)受者的临床资料。收集两组受者围手术期资料、糖皮质激素使用剂量及维持时间、干预治疗以及病情转归等数据,比较常规抗排斥反应治疗方案对肝移植术后AMR与ACR的疗效差异。采用成组t检验比较两组供者年龄、受者年龄、术前终末期肝病模型(model for end-stage liver disease,MELD)评分以及肝移植至诊断ACR或AMR的时间间隔等指标。计数资料以百分比表示,采用Fisher确切概率法比较两组受者原发病、抗排斥反应治疗及联合干预情况。P<0.05为差异有统计学意义。结果AMR发生时间晚于ACR,AMR组和ACR组确诊时间分别为肝移植术后(413±97)d和(12±5)d(t=30.430,P<0.05)。AMR组糖皮质激素治疗时间长于ACR组,分别为(29±15)d和(11±6)d(t=6.122,P<0.05)。在接受标准免疫抑制方案的情况下,与ACR组相比,AMR组需要糖皮质激素冲击治疗的受者比例高于ACR组(8/8和21/50,P<0.05),需要给予联合干预治疗的受者比例也高于ACR组(3/8和0,P<0.05)。结论与ACR相比,AMR通常需要延长糖皮质激素使用疗程,并联合丙种球蛋白、血浆置换及其他方法进行联合干预。展开更多
Paraquat(PQ),a highly effective herbicide,is widely used worldwide.PQ poisoning can cause multiple organ failure,in which the lung is the primary target organ.After PQ poisoning,the patient mortality rate is as high a...Paraquat(PQ),a highly effective herbicide,is widely used worldwide.PQ poisoning can cause multiple organ failure,in which the lung is the primary target organ.After PQ poisoning,the patient mortality rate is as high as 90%,and there is currently no specific antidote.The main clinical treatment is the use of glucocorticoids and cyclophosphamide for pulse therapy,but its effectiveness and safety are still uncertain.We investigated the effectiveness and safety of immunosuppressive pulse therapy with glucocorticoids and cyclophosphamide to evaluate the treatment value in patients with acute PQ poisoning.This meta-analysis,combined with seven trials that enrolled a total of 426 patients,showed that immunosuppressive pulse therapy with glucocorticoids and cyclophosphamide for PQ poisoning significantly reduced mortality of the study group(59.3%,134/226) compared with the control group(81.0%,162/200).There was no significant difference of hepatitis or renal failure between the control and study groups,indicating that immunosuppressive pulse therapy was relatively safe.Several patients were reported to have leukopenia and returned to normal after 1-2 weeks without any abnormalities.Two cases of non-fatal sepsis were reported and considered to be a side effect of the immunosuppressive pulse therapy.Thus,immunosuppressive pulse therapy can efficiently reduce the mortality of PQ poisoning and it is relatively safe.展开更多
文摘目的探讨合理有效的肝移植术后抗体介导排斥反应(AMR)治疗方案。方法回顾性分析2015年3月至2018年12月天津市第一中心医院成人肝移植术后发生AMR受者和同期肝移植术后发生急性细胞性排斥反应(ACR)受者的临床资料。收集两组受者围手术期资料、糖皮质激素使用剂量及维持时间、干预治疗以及病情转归等数据,比较常规抗排斥反应治疗方案对肝移植术后AMR与ACR的疗效差异。采用成组t检验比较两组供者年龄、受者年龄、术前终末期肝病模型(model for end-stage liver disease,MELD)评分以及肝移植至诊断ACR或AMR的时间间隔等指标。计数资料以百分比表示,采用Fisher确切概率法比较两组受者原发病、抗排斥反应治疗及联合干预情况。P<0.05为差异有统计学意义。结果AMR发生时间晚于ACR,AMR组和ACR组确诊时间分别为肝移植术后(413±97)d和(12±5)d(t=30.430,P<0.05)。AMR组糖皮质激素治疗时间长于ACR组,分别为(29±15)d和(11±6)d(t=6.122,P<0.05)。在接受标准免疫抑制方案的情况下,与ACR组相比,AMR组需要糖皮质激素冲击治疗的受者比例高于ACR组(8/8和21/50,P<0.05),需要给予联合干预治疗的受者比例也高于ACR组(3/8和0,P<0.05)。结论与ACR相比,AMR通常需要延长糖皮质激素使用疗程,并联合丙种球蛋白、血浆置换及其他方法进行联合干预。
基金Project supported by the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(No.2017-XK-A36)the Medical and Health Science Foundation of Zhejiang Province(No.2019327552)+1 种基金the Foundation of Key Research Project of Zhejiang Province for Traditional Chinese Medicine(No.2019ZZ014)the Foundation of Science and Technology Department of Zhejiang Province for Beneficial Technology Research of Social Development(No.2015C33146),China
文摘Paraquat(PQ),a highly effective herbicide,is widely used worldwide.PQ poisoning can cause multiple organ failure,in which the lung is the primary target organ.After PQ poisoning,the patient mortality rate is as high as 90%,and there is currently no specific antidote.The main clinical treatment is the use of glucocorticoids and cyclophosphamide for pulse therapy,but its effectiveness and safety are still uncertain.We investigated the effectiveness and safety of immunosuppressive pulse therapy with glucocorticoids and cyclophosphamide to evaluate the treatment value in patients with acute PQ poisoning.This meta-analysis,combined with seven trials that enrolled a total of 426 patients,showed that immunosuppressive pulse therapy with glucocorticoids and cyclophosphamide for PQ poisoning significantly reduced mortality of the study group(59.3%,134/226) compared with the control group(81.0%,162/200).There was no significant difference of hepatitis or renal failure between the control and study groups,indicating that immunosuppressive pulse therapy was relatively safe.Several patients were reported to have leukopenia and returned to normal after 1-2 weeks without any abnormalities.Two cases of non-fatal sepsis were reported and considered to be a side effect of the immunosuppressive pulse therapy.Thus,immunosuppressive pulse therapy can efficiently reduce the mortality of PQ poisoning and it is relatively safe.
