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標題: | 心臟移植後植體血管病變與急性細胞排斥相關性之研究 Correlation between transplant arteriosclerosis and acute cellular rejection in cardiac allografts |
作者: | Shih-Yin Fu 傅詩茵 |
指導教授: | 李啟明 |
關鍵字: | 心臟移植,植體血管病變,急性細胞排斥, heart transplantation,transplant arteriosclerosis,acute cellular rejection, |
出版年 : | 2014 |
學位: | 碩士 |
摘要: | 心臟移植為心臟衰竭末期的治療方式之一。藉由醫療技術的進步,逐漸減少移植一年內的急性細胞排斥,並改善病患存活率,然而對於移植一年後的存活率並無明顯進步,探究造成病患後期死亡的原因,植體血管病變為病因之一。
植體血管病變形態學上為侷限於植體的血管內層瀰漫性、同心圓式地增厚,由於如此,在治療上若執行血管再生術只能達到缺血性症狀的緩解,唯一確切的治療方式為再移植。造成植體血管病變的病因尚未確立,但從血管內層擴散性地增厚並侷限於植體的表現來看,應與移植後的免疫反應較為相關。 急性細胞排斥為移植後可能發生的排斥情況之一,其發生頻率隨著時間逐漸減少,而排斥發生時的治療方式為給予高劑量類固醇或調整免疫抑制劑組合。由於急性細胞排斥較植體血管病變容易處理,因此若能確立兩者之間的相關性則有助於改善心臟移植病患後期存活率。 本研究收錄了68位於心臟移植後12± 3個月區間接受血管內超音波檢查的病患,並以病歷審閱的方式蒐集移植一年內的急性細胞排斥情況、病患基本資料、共病症以及移植後用藥等資訊來進行分析。 初步分析各因子與血管內斑指數之相關性,則男性-女性對比、冠狀動脈心臟病-擴張性心肌病變對比、平均排斥分數與平均排斥次數之相關性達顯著。進一步以多變相逐步回歸分析確立各因子對血管內斑指數的影響力,平均排斥分數與平均排斥次數均再度被選入模式中。研究結果顯示,若病患於移植後一年內發生越多的急性細胞排斥則追蹤之冠狀動脈血管內層增厚程度可能越嚴重。 根據先前文獻回顧,預期HMG-CoA reductase inhibitor及mTOR inhibitor能夠減少植體血管病變,然而於本研究中藥物對血管內斑指數並無顯著影響力,可能因為於此研究中分析樣本數過少以及無法確定病患服藥順從性,而此為未來藥師可加強移植病患用藥衛教之著力點。 Heart transplantation is one of the treatments for end-stage heart failure. With the advance of medicine, the survival of patients done heart transplantation gradually improves by reduceing the acute cellular rejction during 1 year following transplantation. However, there is no obvious improvement in long-term survival. And cardiac allograft vasculopathy (CAV) is one of the causes contributing to the death after 1 year. The morphology of CAV, which is limited to allograft, is diffuse and concentric vascular intimal thickness. Due to this, revascularization can only relieve ischemic symptom and the definite treatment is re-transplantation. Although the exact pathogenesis of CAV remains unknown, several lines of data suggest that it is primarily an immune-mediated disease. Acute cellular rejection is one kind of rejections after transplantation. The incidence of acute cellular rejection is centralized during the first year and decreases as the time passes. Giving steroid pulse therapy or modification of immunossuppresant is the method to deal with it. Acute cellular rejection is easier to manage than CAV and if the correlation between them can be established, it is helpful to ameliorate the survival. The study comprises 68 heart-transplanted patients who receive intravascular ultrasound examination during 12± 3 months after transplantation. Through chart review, patients characteristics, comorbidity, the situation of acute cellular rejection and drug usage are collected. In univariate analysis, male, coronary artery disease, average rejection score and average rejection frequency are associated with the plaque index of CAV. In multivariate analysis, acute rejection score and acute rejection frequency are still significantly associated with the plaque index. The result reveals that the more acute cellular rejection, the severer intimal thickness will be detected. Based on previous literature, HMG-CoA reductase inhibitor and mTOR inhibitor are predicted to reduce CAV. Nevertheless, there are no drug-related effects detected in the study. Small sample size and poor compliance may be the reasons and it is the further point for pharmacists to focus on. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/56804 |
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顯示於系所單位: | 臨床藥學研究所 |
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