两种生物免疫诱导方案对肾移植受者的影响

李健; 许亚宏; 郭瑜; 马小平; 卢奕; 李阳波; 贾志刚; 赵启华; 罗顺文; 陈萍

doi:10.3969/j.issn.1674-7445.2014.05.008

两种生物免疫诱导方案对肾移植受者的影响

doi: 10.3969/j.issn.1674-7445.2014.05.008

610021 成都, 解放军第452医院泌尿外科暨成都军区泌尿外科中心

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许亚宏,Email:apollo99101@126.com

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出版历程
- 收稿日期: 2014-05-08
- 刊出日期: 2014-09-15

Effect of two biological immunologic induction therapies on renal transplant recipients

Department of Urology, Urology Center of Chengdu Military Command, the 452^nd Hospital of Chinese People's Liberation Army, Chengdu 610021, China

摘要

摘要: 目的评估肾移植受者中应用两种不同生物制剂进行免疫诱导治疗的疗效和安全性。方法回顾性分析2008年6月至2013年4月,在解放军第452医院泌尿外科暨成都军区泌尿外科中心应用生物制剂进行免疫诱导治疗的78例尸体肾移植受者的临床资料。根据应用免疫诱导方案不同分为两组,单克隆抗体组(A组,35例,接受巴利昔单抗治疗)和多克隆抗体组[B组,43例,接受抗胸腺细胞球蛋白(ATG)治疗]。另以同期在该院未接受免疫诱导治疗的肾移植受者作为对照组(C组,32例)。分析3组受者术后12周内的人、肾存活情况。监测3组受者术后7、14、30、60 d血清肌酐(Scr)水平变化。比较3组受者急性排斥反应、移植肾功能延迟恢复、感染等并发症的发生率。结果术后12周,3组受体人、肾存活率分别为 A组100%和100%,B组97.7%和97.7%,C组100%和96.9%,各组间比较差异无统计学意义(均为P>0.05)。术后7、14 d,与C组比较,A组和B组的Scr水平明显下降,差异均有统计学意义(均为P<0.05)。与C组比较,A、B两组受者急性排斥反应发生率均降低,差异有统计学意义(均为P<0.05);3组受者移植肾功能延迟恢复发生率比较,差异无统计学意义(均为P>0.05)。B组受者术后感染发生率高于A组和C组,差异均有统计学意义(均为P<0.05)。结论免疫诱导治疗在肾移植受者中应用安全有效。
- 肾移植 /
- 免疫诱导治疗 /
- 巴利昔单抗 /
- 抗胸腺细胞球蛋白 /
- 感染 /
- 移植肾功能延迟恢复
Abstract: Objective To evaluate efficacy and safety of two different biologicals in immunologic induction therapy on renal transplant recipients. Methods Clinical data of 78 renal transplant recipients who received biological immunologic induction therapy in Department of Urology of the 452^nd Hospital of Chinese People's Liberation Army from June 2008 to April 2013,were retrospectively analyzed. According to different biological immunologic induction therapy, the recipients were divided into two groups, monoclonal antibody group(group A, n=35, received treatment of basiliximab) and polyclonal antibody group [group B, n=43, received treatment of antithymocyte globulin(ATG)]. And the other recipients who didn't receive immunologic induction therapy in the hospital during the corresponding period were chosen as control group(group C, n=32). The survival rates of recipient and kidney in 3 groups at 12^th weeks after transplantation were analyzed. The levels of serum creatinine(Scr) of recipients in 3 groups were monitored at 7, 14, 30, 60 d after transplantation. The occurrence rates of complications including acute rejection, delayed graft function and infection were compared among 3 groups. Results At 12^th weeks after transplantation, the survival rates of recipient and kidney in 3 groups were 100% and 100% in group A, 97.7% and 97.7% in group B, 100% and 96.9% in group C. There was no significant difference among 3 groups(all in P>0.05). Compared with group C, the Scr levels in group A and B decreased significantly at 7, 14 d after transplantation(all in P<0.05). Compared with group C, the incidence rates of acute rejection decreased in group A and B(all in P<0.05). There was no significant difference in the incidence rates of delayed graft function among 3 groups(all in P>0.05). The incidence rate of infection in group B was significantly higher than those in group A and C(all in P<0.05). Conclusion Immunologic induction therapy is safe and effective in the application on renal transplant recipients.
- Renal transplantation /
- Immunologic induction therapy /
- Basiliximab /
- Antithymocyte globulin /
- Infection /
- Delayed graft function

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表 1 肾移植供体和受体的临床资料

Table 1. Clinical data of renal transplant donors and recipients

项目	A组（n=35）	B组（n=43）	C组（n=32）
供者年龄(岁， x±s)	27±5	26±6	28±6
受者年龄(岁， x±s)	37±16	39±14	40±15
供者性别(n男/n女)	35/0	43/0	32/0
受者性别(n男/n女)	42609	36/7	27/5
受者原发疾病(n)
慢性肾小球肾炎	28	36	29
慢性肾盂肾炎	1	2	1
糖尿病肾病	2	1	0
多囊肾	1	2	0
高血压肾病	1	0	1
其他	2	2	1
热缺血时间(min， x±s)	10±3	10±3	10±3
冷缺血时间(h， x±s)	12±3	15±4	14±4
CDC（%）	5.1±0.9	4.8±0.6	4.7±0.7
PRA
0～35%(n)	33	41	31
36%～65%(n)	2	2	1
注：DCD为心脏死之器官捐献

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表 2 3组受者术后血清肌酐水平的比较

Table 2. Comparison of serum creatinine level of recipients among three groups after transplantation(μmol/L，(x±s)）

组别	n	术前1 d	术后7 d	术后14 d	术后30 d	术后60 d
A组	35	787±213	89±18a	82±14a	84±15	91±24
B组	43	902±336	97±23a	78±11a	87±18	87±20
C组	32	888±281	132±20	119±18	95±24	97±20
注：与C组比较，^aP<0.05

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