Lonquist J L, Radovancevic B, Vega J D, Burnett C M, Birovljev S, Saade N G, Duncan J M, Frazier O H
Department of Cardiac and Cardiopulmonary Transplantation, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston.
J Heart Lung Transplant. 1992 Sep-Oct;11(5):913-9.
A retrospective analysis was conducted to determine the efficacy and complications resulting from steroid pulse therapy, with or without a steroid taper, in 93 episodes of heart transplant rejection that occurred in 72 patients (58 men, 14 women; mean age, 47.6 years). Each rejection episode was classified according to severity (Texas Heart Institute endomyocardial biopsy scale) and the treatment. Group 1 included 25 episodes of grade 7, 8, 9, or 10 rejection (International Society for Heart Transplantation [ISHT] grade IIIB or IV) that were treated with high-dose methylprednisolone (2.5 to 3.0 gm) and a steroid taper of 1.75 gm over 30 days. Group 2 included 16 episodes of rejection, with the severity of rejection and methylprednisolone pulse therapy being similar to that in group 1, but without a steroid taper. The results of treatment in group 1 were compared with those in group 2. Group 3 included 12 episodes of grade 5, 6, or 7 rejection (ISHT grade IIIA or IIIB) that were treated with moderate-dose methylprednisolone (1.0 to 2.0 gm) and a steroid taper, as described. Group 4 included 40 episodes of rejection, with the severity of rejection and methylprednisolone therapy being similar to that of group 3, but without a steroid taper. The results of treatment in group 3 were compared with those in group 4. No statistically significant differences were found among the groups regarding subsequent episodes of rejection or infection within 3 months of treatment. No statistically significant difference was noted among the groups in the number of rejection episodes requiring additional therapy to control the rejection.(ABSTRACT TRUNCATED AT 250 WORDS)
进行了一项回顾性分析，以确定在72例患者（58例男性，14例女性；平均年龄47.6岁）发生的93次心脏移植排斥反应中，使用或不使用类固醇逐渐减量的类固醇冲击疗法的疗效和并发症。每次排斥反应根据严重程度（德克萨斯心脏研究所心内膜活检量表）和治疗方法进行分类。第1组包括25次7级、8级、9级或10级排斥反应（国际心脏移植学会[ISHT] IIIB级或IV级），采用大剂量甲泼尼龙（2.5至3.0克）治疗，并在30天内逐渐减量至1.75克。第2组包括16次排斥反应，排斥反应的严重程度和甲泼尼龙冲击疗法与第1组相似，但没有类固醇逐渐减量。将第1组的治疗结果与第2组进行比较。第3组包括12次5级、6级或7级排斥反应（ISHT IIIA级或IIIB级），采用中等剂量甲泼尼龙（1.0至2.0克）治疗，并按上述方法进行类固醇逐渐减量。第4组包括40次排斥反应，排斥反应的严重程度和甲泼尼龙治疗与第3组相似，但没有类固醇逐渐减量。将第3组的治疗结果与第4组进行比较。在治疗后3个月内，各组在随后的排斥反应或感染发作方面未发现统计学上的显著差异。在需要额外治疗以控制排斥反应的排斥发作次数上，各组之间未发现统计学上的显著差异。（摘要截短至250字）
