CAJ | 학술논문

目的比较肾移植中应用白细胞介素2受体拮抗剂(IL2Ra)与抗胸腺细胞球蛋白(rATG)行免疫诱导的长期疗效.方法回顾性分析2006年至2010年间的371例肾移植受者,其中使用IL2Ra诱导治疗者261例(IL2Ra组),使用rATG诱导治疗者110例(rATG组).所有受者术后采用钙调磷酸酶抑制剂+吗替麦考酚酯+皮质激素的三联免疫抑制方案,并使用更昔洛韦预防巨细胞病毒感染,使用复方磺胺甲(恶)唑预防卡氏肺孢子虫感染.术后对所有受者随访了1～5年,观察和比较移植肾功能恢复延迟(DGF)、1年内急性排斥反应和感染的发生率,以及受者和移植肾长期存活率等.结果两组间受者性别、年龄、原发病等资料的差异均无统计学意义(P＞0.05),但与IL2Ra组比较,rATG组受者接受的供肾更多来源于尸体供肾(P＜0.01),且供肾冷缺血时间较长(P＜0.01).IL2Ra组和rATG组术后DGF发生率分别为3.1％和1.8％(P＞0.05),术后1年内急性排斥反应发生率分别为10.7％和2.7％ (P＜0.05),感染发生率分别为14.9％和21.8％ (P＞0.05).术后1、2和3年,IL2Ra组受者存活率分别为98.9％、98.9％和98.5％,rATG组均为98.2％ (P＞0.05)；IL2Ra组移植肾存活率分别为98.5％、98.1％和97.7％,rATG组均为97.3％(P＞0.05).结论在临床肾移植中,经rATG诱导治疗较IL2Ra有更低的急性排斥反应发生率,并且不增加发生感染的风险.
목적 비교신이식중응용백세포개소2수체길항제(IL2Ra)여항흉선세포구단백(rATG)행면역유도적장기료효.방법 회고성분석2006년지2010년간적371례신이식수자,기중사용IL2Ra유도치료자261례(IL2Ra조),사용rATG유도치료자110례(rATG조).소유수자술후채용개조린산매억제제+마체맥고분지+피질격소적삼련면역억제방안,병사용경석락위예방거세포병독감염,사용복방광알갑(악)서예방잡씨폐포자충감염.술후대소유수자수방료1～5년,관찰화비교이식신공능회복연지(DGF)、1년내급성배척반응화감염적발생솔,이급수자화이식신장기존활솔등.결과 량조간수자성별、년령、원발병등자료적차이균무통계학의의(P＞0.05),단여IL2Ra조비교,rATG조수자접수적공신경다래원우시체공신(P＜0.01),차공신랭결혈시간교장(P＜0.01).IL2Ra조화rATG조술후DGF발생솔분별위3.1％화1.8％(P＞0.05),술후1년내급성배척반응발생솔분별위10.7％화2.7％ (P＜0.05),감염발생솔분별위14.9％화21.8％ (P＞0.05).술후1、2화3년,IL2Ra조수자존활솔분별위98.9％、98.9％화98.5％,rATG조균위98.2％ (P＞0.05)；IL2Ra조이식신존활솔분별위98.5％、98.1％화97.7％,rATG조균위97.3％(P＞0.05).결론 재림상신이식중,경rATG유도치료교IL2Ra유경저적급성배척반응발생솔,병차불증가발생감염적풍험.
Objective To compare the long-term effectiveness of anti-interleukin-2 receptor antibodies vs.rabbit antithymocyte globulin as induction therapy in kidney transplantation.Methods Between 2006 and 2010,371 recipients of kidney transplants were treated with calcineurin inhibitors (CNI),mycophenolate mofetil and prednisone.261 patients of them received induction therapy with anti-interleukin-2 receptor antibodies (IL2Ra group),and 88 patients received rabbit antithymocyte globulin (rATG group).All the patients received ganciclovir against cytomegalovirus and SMZ against pneumocystis carinii.The data of delayed graft function (DGF),the rate of acute rejectin (AR) and infection in the first year and patient/allograft long survival rate in two groups were retrospectively analyzed during a follow-up period of 1 to 5 years postoperatively.Results There was no significant difference in the sex,age and causes of end-stage renal disease between the two groups.The rATG group had more kidney transplants from deceased donors (P＜0.01 ) and the cold ischemia time was longer than that of the IL2Ra group (P＜0.01 ).The IL2Ra group and the rATG group had similar incidence of DGF (3.1％ vs.1.8％,P＞0.05).One year after operation,the incidence of AR in IL2Ra group and rATG group was 10.7％ and 2.7％ respectively (P＜0.05),and the incidence of infection in IL2Ra group and rATG group was 14.9％ and 21.8％ respectively (P＞0.05).One-,two- and three-year patient survival rate in IL2Ra group was 98.9％,98.9％ and 98.5％ respectively,and that in rATG group was all 98.2％ (P＞0.05).The one-,two- and three-year allograft survival rate in IL2Ra group was 98.5％,98.1％ and 97.7％ respectively,and that in rATG group was all 97.3％ (P＞0.05).Conclusion rATG is more effective than IL2Ra preventing from acute rejection and does not increase the risk of infection for induction in kidney transplant recipients.