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免疫状态量化评估体系指导肝移植术后个体化免疫抑制药管理的临床应用探讨

贾亚男, 朱继巧, 李瀚, 等. 免疫状态量化评估体系指导肝移植术后个体化免疫抑制药管理的临床应用探讨[J]. 器官移植, 2022, 13(6): 803-809. doi: 10.3969/j.issn.1674-7445.2022.06.017
引用本文: 贾亚男, 朱继巧, 李瀚, 等. 免疫状态量化评估体系指导肝移植术后个体化免疫抑制药管理的临床应用探讨[J]. 器官移植, 2022, 13(6): 803-809. doi: 10.3969/j.issn.1674-7445.2022.06.017
Jia Yanan, Zhu Jiqiao, Li Han, et al. Clinical application investigation of quantitative evaluation system of immune status in guiding individualized management of immunosuppressants after liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 803-809. doi: 10.3969/j.issn.1674-7445.2022.06.017
Citation: Jia Yanan, Zhu Jiqiao, Li Han, et al. Clinical application investigation of quantitative evaluation system of immune status in guiding individualized management of immunosuppressants after liver transplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(6): 803-809. doi: 10.3969/j.issn.1674-7445.2022.06.017

免疫状态量化评估体系指导肝移植术后个体化免疫抑制药管理的临床应用探讨

doi: 10.3969/j.issn.1674-7445.2022.06.017
基金项目: 

北京市自然科学基金 7212042

首都医科大学附属北京朝阳医院科技创新基金 21kcjj-4

详细信息
    作者简介:
    通讯作者:

    李先亮,博士,副主任医师,研究方向为肝移植的基础与临床研究,Email:lixianliangbjcy@126.com

  • 中图分类号: R617, R392.4

Clinical application investigation of quantitative evaluation system of immune status in guiding individualized management of immunosuppressants after liver transplantation

More Information
  • 摘要:   目的  探讨免疫状态量化评估体系对肝移植术后受者免疫抑制药个体化管理的指导作用。  方法  回顾性分析239例肝移植受者的临床资料,建立铭道免疫细胞状态全面评估体系(MICA),根据免疫抑制药的调整方法将受者分为两组,其中根据铭道免疫状态量化评分标准(MISS)评分调整免疫抑制药用药方案的为MISS评分组(84例),同期按经验性用药调整用药方案的为常规对照组(155例)。在MISS评分组中,根据术后检测时间(t)将受者分为A组(t≤28 d,78例次)、B组(28 d < t≤6个月,68例次)、C组(6个月< t≤12个月,18例次)、D组(12个月< t≤24个月,18例次)和E组(t > 24个月,19例次)。分析MISS评分组中A~E组受者术后MISS评分情况、比较两组受者急性排斥反应和机会性感染的发生情况以及总体生存率。  结果  A~E组的MISS评分分别为-7.0(-13.2,-2.0)分、-2.0(-5.8,1.8)分、-0.5(-7.3,2.8)分、-2.0(-4.5,3.3)分、-3.0(-6.0,1.0)分,受者的免疫状态随术后时间的延长而逐渐改善,组间比较差异有统计学意义(P < 0.05)。MISS评分组受者中有15%(13/84)发生急性排斥反应,常规对照组受者中有27%(42/155)发生急性排斥反应,差异有统计学意义(P < 0.05)。在MISS评分组中,发生急性排斥反应的受者MISS评分为0(-2.5,3.5)分,未发生急性排斥反应的受者为-5.0(-12.0,-1.0)分,差异有统计学意义(P < 0.05)。MISS评分组受者中有2%(2/84)发生术后机会性感染,常规对照组受者中有9%(14/155)发生术后机会性感染,差异有统计学意义(P < 0.05)。MISS评分组受者1年、3年总体生存率分别为86.9%、79.8%,常规对照组分别为83.2%、76.8%,两组受者术后总体生存率差异无统计学意义(P > 0.05)。  结论  应用MICA免疫状态分析和MISS免疫评分能够反映肝移植受者免疫状态,指导肝移植受者术后免疫抑制药个体化应用管理。

     

  • 图  1  MICA分析方法中主要淋巴细胞亚群流式分析门设置

    Figure  1.  Flow cytometry gate settings for main lymphocyte subsets in MICA analysis

    图  2  MISS免疫评分尺

    Figure  2.  MISS immune scale

    图  3  两组受者总体生存率比较

    Figure  3.  Comparison of the overall survival rate of the recipients between two groups

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出版历程
  • 收稿日期:  2022-07-25
  • 网络出版日期:  2022-11-14
  • 刊出日期:  2022-11-15

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