供体骨髓干细胞输注联合肝移植治疗终末期肝病的近期效果观察

目的评价供体骨髓干细胞输注联合肝移植治疗终末期肝病的近期效果。方法2008年3月至2009年1月本中心30例肝移植受者分为两组，实验组8例，行同期供体骨髓干细胞联合肝脏移植；对照组22例，仅行肝脏移植，不行骨髓干细胞输注。观察两组受者术后免疫抑制剂（甲基强的松龙、他克莫司）用量、肝功能（谷氨酸转氨酶、天冬氨酸转氨酶等）变化、急性排斥反应和感染并发症发生情况，以及术后住院时间和费用。采用，检验、方差分析及确切概率法进行统计学分析。结果实验组术后甲基强的松龙总用量和出院时每日他克莫司用量显著低于对照组[甲基强的松龙分别为（1314±105）mg，（1884±256）mg，t=6．060，P=0．000；他克莫司分别为（3．73±0．35）mg／d，（4．93±0．62）mg／d，，=5．147，P=0．000]。术后第1天实验组血清谷氨酸转氨酶、天冬氨酸转氨酶均显著低于对照组[谷氨酸转氨酶分别为（875．2±325．5）IU／L，（1350．4±482．7）IU／L，t=2．543，P=0．016，天冬氨酸转氨酶分别为（646．2±184．9）IU／L，（1021．8±325．4）IU／L，t=3．067，P=0．005]。术后第3天也低于对照组[谷氨酸转氨酶分别为（252．9±35．8）IU／L，（343．5±47．8）IU／L，f=4．866，P=0．000，天冬氨酸转氨酶分别为（227．8±38．0）IU／L，（310．8±61．7）IU／L，t=3．545，P=0．001]。结论同期供体骨髓干细胞联合肝脏移植可以降低术后免疫抑制剂用量，减轻术后早期肝脏损伤，不增加治疗风险，是一种安全有效的治疗方法。

Simultaneous infusion of donor bone marrow stem cells promotes postoperative recovery in liver recipients

Objective To evaluate the clinical efficacy of donor stem cell infusion in the patients receving liver transplantation in the early postoperative period. Methods Eight ptients in experimental group received simultaneous bone marrow stem cell infusion and liver transplantation, while 22 patients in control group were not given bone marrow stem cell infusion. Dosage of immunosuppressants, liver function, acute rejection, infection episode, length of stay （LOS） and cost were compared between the two groups. Results The postoperative dosage of Methylprednisolone and daily dosage of tacrolimus were both significantly lower in experimental group than those in control group [Methylprednisolone： （1314 ± 105） mg vs （1884 ± 256） mg, t = 6.060, P = 0.000; FK506：（3.73 ± 0.35） mg/d vs （4.93 ±0.62） mg/d, t = 5.147, P = 0.000]. Both serum alanine aminotransferase and aspartate aminotransferase levels in experimental group were remarkably lower than those in control group at 1 and 3 d after the operation[alanine aminotransferase：（875.2 ± 325.5a） IU/L vs 1350.4 ± 482.7 IU/L, t = 2.543, P = 0.016, aspartate aminotransferase：（646.2 ± 184.9） 1U/L vs （1021.8 ± 325.4） IU/L, at = 3.067, P = 0.005]. Conclusion As a safe and effective approach, infusion of donor bone marrow stem cell during liver transplantation could efficiently decrease the dosage of immunosuppressants, which alleviates early hepatic injury.