CAJ | 학술논문

目的探讨肾移植受者预防性应用兔抗人胸腺细胞免疫球蛋白(ATG-R)的有效性和安全性.方法选择2003年5月至2006年12月期间的肾移植受者655例,分为试验组(84例)和对照组(571例).两组受者在年龄、性别、群体反应抗体(PRA)、HLA配型、常规免疫抑制剂的应用等方面比较,差异无统计学意义.对试验组受者采取术前1次较大剂量(1.5 mg/kg)和术后短时间小剂量(0.5～1 mg/kg)预防性应用ATG-R;对照组受者仅采用常规免疫抑制方案.分析和比较两组受者术后移植物功能延迟恢复(DGF)发生率、术后6个月内急性排斥反应(AR)发生率、术后6个月内感染发生率及人/肾1年存活率等指标.结果试验组和对照组DGF发生率分别为2.38%和8.40%,试验组明显低于对照组,差异有统计学意义(P＜0.01);术后6个月内AR发生率分别为4.76%和11.03%,试验组低于对照组,差异有统计学意义(P＜0.05);试验组和对照组术后6个月内感染发生率分别为10.71%和9.81%,两组比较,差异无统计学意义(P＞0.05).两组的人/肾1年存活率比较,差异也无统计学意义(P＞0.05).结论肾移植受者预防性应用ATG-R能够明显降低DGF和AR发生率,且不增加感染发生率,是一种有效和安全的免疫诱导措施.
목적 탐토신이식수자예방성응용토항인흉선세포면역구단백(ATG-R)적유효성화안전성.방법 선택2003년5월지2006년12월기간적신이식수자655례,분위시험조(84례)화대조조(571례).량조수자재년령、성별、군체반응항체(PRA)、HLA배형、상규면역억제제적응용등방면비교,차이무통계학의의.대시험조수자채취술전1차교대제량(1.5 mg/kg)화술후단시간소제량(0.5～1 mg/kg)예방성응용ATG-R;대조조수자부채용상규면역억제방안.분석화비교량조수자술후이식물공능연지회복(DGF)발생솔、술후6개월내급성배척반응(AR)발생솔、술후6개월내감염발생솔급인/신1년존활솔등지표.결과 시험조화대조조DGF발생솔분별위2.38%화8.40%,시험조명현저우대조조,차이유통계학의의(P＜0.01);술후6개월내AR발생솔분별위4.76%화11.03%,시험조저우대조조,차이유통계학의의(P＜0.05);시험조화대조조술후6개월내감염발생솔분별위10.71%화9.81%,량조비교,차이무통계학의의(P＞0.05).량조적인/신1년존활솔비교,차이야무통계학의의(P＞0.05).결론 신이식수자예방성응용ATG-R능구명현강저DGF화AR발생솔,차불증가감염발생솔,시일충유효화안전적면역유도조시.
Objective To study the efficacy and safety of prophylactic application of rabbit antithymocyte globulin(ATG-R)in renal transplantation.Methods Between May 2003 and December 2006,655 cases of kidney recipients were selected at our hospital,and divided into experiment group(n=84)and control group(n=571)according to the prophylactic application of ATG-R.There was no apparent difference in age,sex,PRA,HLA match and other immunosuppression administration between two groups.For experiment group,single bolus high dose(1.5 mg/kg)before operation and short-time lower dose(0.5-1 mg/kg)ATG-R after transplantation ATG-R were given as prophylactic application.DGF and 6-month AR rate,6-month infection rate,one-year graft and recipient survival rate were compared.Results In experiment and control groups,DGF rate was 2.38 % and 8.40 % respectively,P＜0.01;6-month AR rate was 4.76 % and 11.03 % respectively,P＜0.05.6-month infection rate was 10.71 % and 9.81 % respectively,P＞0.05.There was no difference in one-year graft and recipient survival rate between two groups,P＞0.05.Conclusion For kidney recipients,the prophylactic application of ATG-R could reduce DGF and AR rate significantly,but not increase infection rate,suggesting it is an effective and safe immunity induction method.