CAJ | 학술논문

目的研究人源化抗CD52单克隆抗体(阿来佐单抗)与抗CD25单克隆抗体(达利珠单抗)在小肠移植诱导治疗中的临床疗效.方法回顾性分析2007年至2012年间1 1例小肠移植受者的临床资料,其中6例在小肠移植时使用了阿来佐单抗(阿来佐单抗组),5例应用了达利珠单抗(达利珠单抗组).观察术前和术后12周内受者外周血淋巴细胞及单核细胞的变化情况,术后3个月内排斥反应、感染的发生情况,以及受者肝、肾功能的变化情况.结果阿来佐单抗组受者中,1例因发生急性心功能衰竭于术后13 d死亡,余5例术后8周内外周血淋巴细胞、单核细胞显著下降,8周后开始缓慢上升,外周血CD3+、CD4+及CD8+T淋巴细胞的百分比下降至给药前的5％,并在给药后8周内维持在稳定的低水平.达利珠单抗组受者中,1例因曲霉感染于术后25 d死亡,余4例受者淋巴细胞、单核细胞计数在给药后1d明显增加,1周后持续稳定在正常水平.术后3个月内,阿来佐单抗组检出轻度排斥反应1例,达利珠单抗组检出轻、中、重度排斥反应各1例,经及时抗排斥反应治疗后成功好转.11例受者术后3个月时血肌酐、尿素氮、丙氨酸转氨酶、胆红素总量与术前相比,无明显差异.结论应用阿来佐单抗或达利珠单抗均可成功进行小肠移植免疫诱导,但阿来佐单抗诱导后的感染发生率更低.
목적 연구인원화항CD52단극륭항체(아래좌단항)여항CD25단극륭항체(체리주단항)재소장이식유도치료중적림상료효.방법 회고성분석2007년지2012년간1 1례소장이식수자적림상자료,기중6례재소장이식시사용료아래좌단항(아래좌단항조),5례응용료체리주단항(체리주단항조).관찰술전화술후12주내수자외주혈림파세포급단핵세포적변화정황,술후3개월내배척반응、감염적발생정황,이급수자간、신공능적변화정황.결과 아래좌단항조수자중,1례인발생급성심공능쇠갈우술후13 d사망,여5례술후8주내외주혈림파세포、단핵세포현저하강,8주후개시완만상승,외주혈CD3+、CD4+급CD8+T림파세포적백분비하강지급약전적5％,병재급약후8주내유지재은정적저수평.체리주단항조수자중,1례인곡매감염우술후25 d사망,여4례수자림파세포、단핵세포계수재급약후1d명현증가,1주후지속은정재정상수평.술후3개월내,아래좌단항조검출경도배척반응1례,체리주단항조검출경、중、중도배척반응각1례,경급시항배척반응치료후성공호전.11례수자술후3개월시혈기항、뇨소담、병안산전안매、담홍소총량여술전상비,무명현차이.결론 응용아래좌단항혹체리주단항균가성공진행소장이식면역유도,단아래좌단항유도후적감염발생솔경저.
Objective To evaluate the clinical efficiency of humanized anti-CD52 monoclonal antibody (Campath-1H) and anti-CD25 monoclonal antibody (Zenapax) induction therapy in intestinal transplantation patients.Method The data of 6 patients receiving Campath-1H and 5 patients receving Zenapax induction therapy in intestinal transplantation between 2007 and 2012 were analyzed retrospectively.The counts of peripheral blood lymphocytes and monocytes,incidence of rejection and infention,and liver and kidney toxicity of recipients were recorded before and 3 months after transplantation.Results Of 6 intestinal transplantation patients receiving Campath-1H induction therapy,1 died of acute heart failure on the postoperative day 3,and the rest 5 patients had a powerful depletion of lymphocytes and monocytes in 8 weeks,followed by gradual increases after 8 weeks.The percentage of peripheral blood CD3 + T cells,CD4 + T cells,and CD8 + T cells was dropped to 5％ before administration,and remained at a steady low level in the first 8 weeks after induction.Of 5 patients receiving Zenapax induction therapy,1 died of Aspergillus infection on the postoperative day 25,and the rest 4 patients had an obeivous increase of lymphocytes and monocytes on the postoperative day 1.Counts of lymphocytes and monocytes kept steady at normal levels from the 1st to 12th week.One case of mild rejection was found in Campath-1H group.One case of mild,one moderate and one severe rejection were detected in Zenapax group.All rejections were successfully cured by prompt anti-rejection therapy.There were no significant difference in serum creatimine,urea nitrogen,alanine aminotransferase or total bilirubin after 3 months in comparison to preoperation.Conclusion Both Campath-1H induction therapy and Zenapax induction therapy successfully induce immune tolerance in patients with intestinal transplantation.Campath-1H seems to offer better immunosuppression against Zenapax during the first 3 months posttransplantation.