摘要
目的探讨原位心脏移植术后心内膜心肌活检(EMB)的必要性和安全性。方法62例心脏病患者接受原位心脏移植,采用两剂巴利昔单抗诱导,环孢素A、霉酚酸酯(或硫唑嘌呤)及泼尼松维持免疫抑制治疗。术后3周、3～4个月、5～6个月、12个月常规进行EMB,对发生无法解释的心率明显变化、新出现的心律失常或心功能下降者加作EMB,每次于右室室间隔的不同部位夹取5～7块心肌组织。按照国际心肺移植协会的病理分级标准进行分级。取材后进行心电图、超声心动图检查,并摄X线胸片,以判断EMB后并发症。结果随访(18.0±7.0)个月,58例(93.5%)存活,共行213例次EMB,10例次(4.7%)诊断为排斥反应Ⅲ级,19例次(8.9%)为Ⅱ级,184例次(86.4%)为0+Ⅰ级。临床怀疑排斥反应者12例次,加做EMB,4例次(33.3%)诊断为排斥反应Ⅲ级,8例次(66.7%)为0+Ⅰ级。EMB后,2例次(0.9%)发生三尖瓣返流,但未见右心功能不全;2例(0.9%)出现一过性完全性右束支传导阻滞。结论即使是使用高效免疫抑制剂的今天,EMB仍是监测心脏移植后排斥反应的必要和安全的方法。
Objective To retrospectively evaluate the necessity and safety of 213 endomyocardial biopsies （EMB） which were performed on 62 cardiac transplant recipients. Methods Cardiac transplantation was performed on 62 consecutive recipients aged 13-67 （average 45.3±14. 3） years old within 31 months. Basiliximab as induction agent was administered to all recipients. The triple immunosuppressive regimen consisted of cyclosporine/tacrolimus, mycophenolate mofetil/azathioprine and predisone. All recipients underwent routine noninvasive rejection surveillance that included clinical examination and echocardiography. Routine EMBs were performed 3 weeks and 3-4, 5-6, 12 months after transplantation. Clinically suspected rejection and antirejection therapy efficacy needed additional EMB surveillance. Electrocardiograms, echocardiograms and fluoroscopies of the chest were performed to evaluate safety of EMB. Results Among 213 EMB, there were 12 EMB of clinically suspected rejection. There were 10 （4.7%）, 19（8.9%） and 184 （86.4%） cell rejection episodes of Inter-national Society for Heart and Lung Transplantation grade Ⅲ, Ⅱ and 0 ＋ I , respectively. The results of 12 EMB of clinically suspected rejection showed 4 （33.3%） and 8 （66. 7%） cell rejection episodes of grade Ⅲ and grade 0 ＋ I , respectively. Only 2 （0.9%） episodes of new mild to moderate tricuspid regurgitation and 2 （0.9%） episodes of transient non-complete right bundle branch block were pre-sent in 213 EMB. The survival rate was 93.5% during a following-up of 18.0±7.0 months. Conclusion EMB was a safe and necessary way to rejection surveillance in symptomatic and asymptomatic heart transplantation recipients.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2007年第11期672-674,共3页
Chinese Journal of Organ Transplantation
