中华细胞与干细胞杂志（电子版）
中華細胞與榦細胞雜誌（電子版）
중화세포여간세포잡지（전자판）
CHINESE JOURNAL OF CELL AND STEM CELL
2012年
1期
31-36
,共6页
陈正%张善斌%廖德怀%方佳丽%李光辉%杜杨春%徐璐%潘光辉
陳正%張善斌%廖德懷%方佳麗%李光輝%杜楊春%徐璐%潘光輝
진정%장선빈%료덕부%방가려%리광휘%두양춘%서로%반광휘
肾移植%免疫耐受%CD25单克隆抗体%抗胸腺淋巴细胞球蛋白
腎移植%免疫耐受%CD25單剋隆抗體%抗胸腺淋巴細胞毬蛋白
신이식%면역내수%CD25단극륭항체%항흉선림파세포구단백
Renal transplantation%Immune tolerance%CD25 Monoclonal Antibody%Anti-human T-lymphocyte Globuin
目的 探讨单剂CD25单克隆抗体(舒莱/赛呢哌)联合小剂量兔抗胸腺淋巴细胞球蛋白(ATG)免疫诱导方案在肾移植预防排斥反应中的有效性和安全性.方法 回顾分析741例肾移植临床资料.诱导组448例,于术前2h静脉滴注CD25单克隆抗体单剂(舒莱/赛呢哌),肾移植手术当日及术后第2日分别静脉滴注ATG 100 mg,术后第3～6日分别静脉滴注ATG 50 ng,术后免疫抑制维持治疗减量.诱导组中141例属肾移植高危人群.对照组293例,均未行免疫诱导治疗,移植术后常规剂量的免疫抑制维持.所有病例均随访了12个月以上,比较两组的1年人/肾存活率、急性排斥发生率和治愈率、感染发生率及白细胞计数变化.结果 诱导组非高危人群急性排斥反应(AR)发生率8.1％ (25/307),感染发生率7.2％ (22/307),明显低于对照组的14.7％ (43/293,P=0.024)和15.4％ (45/293,P=0.006).诱导组非高危人群的移植肾1年存活率99.7％,排斥逆转率为100％ (25/25),高于对照组的95.9％ (P=0.024)和88.4％ (38/43,P＜0.01).诱导组高危人群的AR发生率为14.9％ (21/141),感染发生率为13.5％ (19/141),移植肾1年存活率为95.0％,与对照组比较无显著差异(P均＞0.05).诱导组术后3d和7d的白细胞计数分别为(8.88±3.34)×109/L,(7.03±3.24)×109/L,低于对照组(P=0.002、0.007),诱导组术后3d和7d的淋巴细胞计数(0.47±0.23)×109/L,(0.74±0.41)×109/L明显低于对照组(P均=0.000),术后第10d两者比较无差异(P均＞0.05).结论 单剂CD25单克隆抗体联合小剂量ATG方案在肾移植免疫诱导中具有重要的临床应用价值,可降低术后年内AR发生率、降低感染发生率,提高1年人(肾)存活率,尤其适于高危人群.
目的 探討單劑CD25單剋隆抗體(舒萊/賽呢哌)聯閤小劑量兔抗胸腺淋巴細胞毬蛋白(ATG)免疫誘導方案在腎移植預防排斥反應中的有效性和安全性.方法 迴顧分析741例腎移植臨床資料.誘導組448例,于術前2h靜脈滴註CD25單剋隆抗體單劑(舒萊/賽呢哌),腎移植手術噹日及術後第2日分彆靜脈滴註ATG 100 mg,術後第3～6日分彆靜脈滴註ATG 50 ng,術後免疫抑製維持治療減量.誘導組中141例屬腎移植高危人群.對照組293例,均未行免疫誘導治療,移植術後常規劑量的免疫抑製維持.所有病例均隨訪瞭12箇月以上,比較兩組的1年人/腎存活率、急性排斥髮生率和治愈率、感染髮生率及白細胞計數變化.結果 誘導組非高危人群急性排斥反應(AR)髮生率8.1％ (25/307),感染髮生率7.2％ (22/307),明顯低于對照組的14.7％ (43/293,P=0.024)和15.4％ (45/293,P=0.006).誘導組非高危人群的移植腎1年存活率99.7％,排斥逆轉率為100％ (25/25),高于對照組的95.9％ (P=0.024)和88.4％ (38/43,P＜0.01).誘導組高危人群的AR髮生率為14.9％ (21/141),感染髮生率為13.5％ (19/141),移植腎1年存活率為95.0％,與對照組比較無顯著差異(P均＞0.05).誘導組術後3d和7d的白細胞計數分彆為(8.88±3.34)×109/L,(7.03±3.24)×109/L,低于對照組(P=0.002、0.007),誘導組術後3d和7d的淋巴細胞計數(0.47±0.23)×109/L,(0.74±0.41)×109/L明顯低于對照組(P均=0.000),術後第10d兩者比較無差異(P均＞0.05).結論 單劑CD25單剋隆抗體聯閤小劑量ATG方案在腎移植免疫誘導中具有重要的臨床應用價值,可降低術後年內AR髮生率、降低感染髮生率,提高1年人(腎)存活率,尤其適于高危人群.
목적 탐토단제CD25단극륭항체(서래/새니고)연합소제량토항흉선림파세포구단백(ATG)면역유도방안재신이식예방배척반응중적유효성화안전성.방법 회고분석741례신이식림상자료.유도조448례,우술전2h정맥적주CD25단극륭항체단제(서래/새니고),신이식수술당일급술후제2일분별정맥적주ATG 100 mg,술후제3～6일분별정맥적주ATG 50 ng,술후면역억제유지치료감량.유도조중141례속신이식고위인군.대조조293례,균미행면역유도치료,이식술후상규제량적면역억제유지.소유병례균수방료12개월이상,비교량조적1년인/신존활솔、급성배척발생솔화치유솔、감염발생솔급백세포계수변화.결과 유도조비고위인군급성배척반응(AR)발생솔8.1％ (25/307),감염발생솔7.2％ (22/307),명현저우대조조적14.7％ (43/293,P=0.024)화15.4％ (45/293,P=0.006).유도조비고위인군적이식신1년존활솔99.7％,배척역전솔위100％ (25/25),고우대조조적95.9％ (P=0.024)화88.4％ (38/43,P＜0.01).유도조고위인군적AR발생솔위14.9％ (21/141),감염발생솔위13.5％ (19/141),이식신1년존활솔위95.0％,여대조조비교무현저차이(P균＞0.05).유도조술후3d화7d적백세포계수분별위(8.88±3.34)×109/L,(7.03±3.24)×109/L,저우대조조(P=0.002、0.007),유도조술후3d화7d적림파세포계수(0.47±0.23)×109/L,(0.74±0.41)×109/L명현저우대조조(P균=0.000),술후제10d량자비교무차이(P균＞0.05).결론 단제CD25단극륭항체연합소제량ATG방안재신이식면역유도중구유중요적림상응용개치,가강저술후년내AR발생솔、강저감염발생솔,제고1년인(신)존활솔,우기괄우고위인군.
Objective To evaluate the safety and efficiency of single-dose CD25 Mab (Simulete/Zenapax) combined with low-dose anti-human T-lymphocyte globulin (ATG) as induction therapy in kidney transplant recipients (especially the high-risk ones).Methods A retrospective analysis of 741 cases of kidney transplant recipients in our hospital from January 2000 to December 2006 was performed.The recipients were divided into two groups.Patients in induction group (n =448) received CD25 Mab + ATG and there were 141 high-risk recipients.CD25 Mab was given intravenously within 2 hours pretransplent and ATG was given intravenously within 7 days (100 mg pretransplant,1st and 2nd day posttransplant; 50 mg from 3rd to 6th day posttransplant); Low dose of immunosuppressant was given after transplantation.Patients in control group (n =293) received CsA/FKS06 + MMF + Pred.All patients were followed up for at least 12 months.The clinical efficiency (one-year survival,acute rejection rate,infection rate,serum creatinine level and WBC) and safety profile were compared between the two groups.Results For low-risk patients in induction group,incidence of acute rejection was 8.1％ (25/307) and all were cured.Infection rate was 7.2 ％ (22/307) and no CMV infection was observed.One year recipient/renal survival rate was 99.7 ％/99.7 ％.For high-risk patients in induction group one year recipient/renal survival rate was 96.5 ％/95.0 ％; Incidence of acute rejection was 14.9％(21/141) and 90.5％(19/21) was cured.Infection rate was 13.5％(19/141),with one CMV infection.In control group,one year recipient/renal survival rate was 97.6％/95.9 ％.Incidence of acute rejection was 14.7 ％ (43/293) and 88.4 ％ (38/43) was cured.Infection rate was 15.4％(45/293) and 2 eases of CMV infection were diagnosed.At days 3 and 7,WBC in the induction groups were (8.88 ± 3.34)× 109/L and (7.03 ± 3.24)× 109/L respectively,lower than those of control group (P =0.002、0.007).At days 3 and 7,lymphocyte count in the induction groups were (0.47 ± 0.23)×109/L and (0.74 ± 0.41)×109/L respectively,lower than those of control group(P =0.000).No difference was noted at day 10.There was significant difference in incidence of acute rejection,infection rate,survival rate and kidney survival rate between the control group and low-risk patients in induction group.Conclusion The induction therapy with single-dose CD25 Mab and low-dose ATG has important role in renal transplantation,particularly for high-risk recipients.This induction therapy can decrease the incidence of acute rejection and infection,leading to a higher person/kidney survival rate.
