摘要
目的探讨原发性肝细胞癌(肝癌)肝移植术后肿瘤复发患者在减少钙调磷酸酶抑制剂(他克莫司或环孢素)剂量并联用西罗莫司的临床疗效。方法 24例复发患者随机分为两组:研究组12例,确诊复发后即将钙调磷酸酶抑制剂减量并联合应用西罗莫司(3mg/d,连用3d后改为1.5mg/d,按血药谷浓度4～8ng/ml调整用量)治疗;对照组12例,继续原免疫抑制方案。比较两组患者的带瘤生存时间、排斥反应及其他不良反应发生情况。结果 两组患者的带瘤生存时间分别为3～37个月(中位数17个月)和1～50个月(中位数4个月),两组比较差异有统计学意义(P<0.05)。研究组1例患者发生急性排斥反应,增加他克莫司用量排斥反应得以控制,对照组无患者发生排斥反应,两组排斥反应发生率比较差异无统计学意义(P>0.05)。研究组高脂血症发生率较高(50%),两组患者的其他不良反应发生率差异无统计学意义(P>0.05)。结论 西罗莫司能显著延长肝癌肝移植术后肿瘤复发患者的带瘤生存时间,并不增加排斥反应发生率,为肝移植术后肿瘤复发的治疗提供了一种新的选择。
Objective To investigate the therapeutic effect of sirolimus application combined with dose-decreased calcineurin inhibitors on patients with tumor recurrence after orthotopic liver transplantation（OLT）.Methods Between January 2005 and March 2008,24 patients with tumor recurrence after OLT in our transplant center were enrolled in this study.Twelve patients（study group） were chosen randomly from the 24 patients and converted to sirolimus-based immunosuppression regimen after tumor recurrence（sirolimus was given at an initial loading dose of 3 mg/d for 3 days and followed by 1.5 mg/d with trough levels,which were maintained in the 4-8 ng/ml range）.The remaining 12 patients with their original immunosuppression regimen were studied as control group.The survival time of tumor bearing,the ratio of rejection and toxicity predicted to be associated with the drugs were compared between the two groups.Results In the study group,the median survival time in the presence of tumor was 17 months（3-37 months）.In the control group,the median survival time in the presence of tumor was 4 months（1-50 months）.There was significant difference in the survival time of tumor bearing after recurrence between these two groups（P0.05）.One recipient experienced acute rejection in the study group and the rejection was controlled by adding the dose of tacrolimus（FK506）.There was no acute rejection episode in the control group.But no statistically significant difference was observed（P0.05）.Compared with the control group,the study group had a higher rate of hyperlipemia（50 %）.There was no significant difference in the rate of other adverse reaction between these two groups（P0.05）.Conclusion Sirolimus is an effective immunosuppressant.At the same time,it may inhibit the growth of tumor and prolong the survival time of patients with tumor recurrence after OLT.It provides a new choice for the treatment of tumor recurrence after liver transplantation.
出处
《器官移植》
CAS
2011年第2期73-76,共4页
Organ Transplantation
基金
国家重点基础研究发展计划(973计划)课题(2009CB522404)
国家十一五科技重大专项课题(2008ZX10002-026)
教育部博士点基金(20090171110071)
广州市科技计划项目(200921Z1-E211)
关键词
西罗莫司
肝细胞癌
肝移植
肿瘤复发
钙调磷酸酶抑制剂
Sirolimus
Hepatocellular carcinoma
Liver transplantation
Tumor recurrence
Calcineurin inhibitors
