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中华移植杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 1 -12. doi: 10.3877/cma.j.issn.1674-3903.2023.01.001

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器官移植受者新型冠状病毒感染防治策略与健康管理中国专家指导意见(第一版)
中国器官移植发展基金会器官移植受者健康管理专家委员会   
  • 收稿日期:2022-12-24 出版日期:2023-02-25
  • 基金资助:
    中国器官移植发展基金会器官移植受者健康管理专项基金(COTDF-020004)

Expert guidance on prophylaxis strategies and health management of organ transplant recipients infected with COVID-19 in China (first edition)

Committee of Health Management for Organ Transplant Recipient, China Organ Transplantation Development Foundation   

  • Received:2022-12-24 Published:2023-02-25
引用本文:

中国器官移植发展基金会器官移植受者健康管理专家委员会. 器官移植受者新型冠状病毒感染防治策略与健康管理中国专家指导意见(第一版)[J]. 中华移植杂志(电子版), 2023, 17(01): 1-12.

Committee of Health Management for Organ Transplant Recipient, China Organ Transplantation Development Foundation. Expert guidance on prophylaxis strategies and health management of organ transplant recipients infected with COVID-19 in China (first edition)[J]. Chinese Journal of Transplantation(Electronic Edition), 2023, 17(01): 1-12.

自2019年新型冠状病毒感染(COVID-19)首次发现以来,截至2022年12月21日,全球确诊病例已超过6.49亿例,且死亡病例达660多万例[1]。目前我国境外输入和本土疫情的新型冠状病毒(以下简称"新冠病毒")主要流行株是奥密克戎变异株[2]。该病毒变异株传染性更强、传播速度更快、再感染率更高,在已接种新型冠状病毒疫苗(以下简称"新冠疫苗")的人群中易发生免疫逃避及突破感染[3]。实体器官移植受者(solid organ transplant recipient,SOTR)因长期使用免疫抑制剂,且可能伴有高血压、糖尿病等慢性基础性疾病,感染新冠病毒后重症率和病死率均高于普通人群[4]。按照中华人民共和国国家卫生健康委员会印发的《新型冠状病毒感染诊疗方案(试行第十版)》[5]中将"免疫功能缺陷(如长期使用皮质类固醇或其他免疫抑制药物导致免疫功能减退状态)"人群列为重型/危重型高危人群之一。因此,应高度重视SOTR感染新冠病毒的健康管理,优化其预防、早期诊断和治疗策略。

图1 奈玛特韦/利托那韦用药期间钙调磷酸酶抑制剂使用管理[56]
表1 与奈玛特韦/利托那韦存在相互作用的常见药物
表2 COVID-19实体器官移植受者免疫抑制方案调整基本原则*
COVID-19临床分型 免疫抑制方案
轻型 (1)移植物功能稳定,免疫抑制方案暂不调整,密切关注病情;
(2)根据移植物功能、免疫抑制剂血药浓度、血白细胞下降和细胞免疫状态,调整免疫抑制方案,停用抗增殖类药物,密切关注病情;
(3)口服Paxlovid等影响CNI血药浓度的药物前,停用CNI,予适量糖皮质激素替代治疗。注意监测免疫抑制剂血药浓度(包括哺乳动物雷帕霉素靶蛋白抑制剂)、移植物功能和细胞免疫状态。停用Paxlovid后,逐渐恢复CNI用药,起始剂量25%~75%,密切监测血药浓度,以及时作出调整。
中型 (1)根据移植物功能以及细胞和体液免疫监测情况,适时调整免疫抑制强度,停用抗增殖类药物,密切关注移植物功能和病情变化;
(2)口服Paxlovid等影响CNI血药浓度的药物前,停用CNI,监测移植物功能、免疫抑制剂血药浓度和机体免疫功能,予小剂量糖皮质激素(地塞米松磷酸钠或甲泼尼龙等)替代治疗。停用Paxlovid后,逐渐恢复CNI用药,起始剂量25%~75%,密切监测血药浓度,以及时作出调整。
重型 (1)推荐大剂量免疫球蛋白(连用3~7 d),停用所有口服免疫抑制剂,病情好转后参照"中型"免疫抑制方案执行;
(2)必要时短期(3~5 d)适量增加糖皮质激素用量,停用所有口服免疫抑制剂,病情好转后参照"中型"免疫抑制方案执行。
危重型 参照"重型"免疫抑制方案,病情好转后参照"中型"免疫抑制方案执行。
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