中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (18): 3236-3240.doi: 10.3969/j.issn.1673-8225.2012.18.002

• 肾移植 kidney transplantation • 上一篇    下一篇

肾移植后不同抗排斥治疗方案感染及急性排斥发生率的比较★

黄效维1，刘  洲2，谢敏妍1   

  1. 1广州市番禺区中心医院肾内科，广东省广州市 511400；2解放军第四五八医院，广东省广州市510602
  • 收稿日期:2011-11-28 修回日期:2011-12-16 出版日期:2012-04-29 发布日期:2012-04-29
  • 通讯作者: 刘洲，博士，正主任医师，解放军第四五八医院器官移植中心，广东省广州市 510602
  • 作者简介:黄效维★，男，1973年生，广东省广州市人，1997年中山医科大学毕业，硕士，主治医师，原工作单位为广州医学院第三附属医院，现在广州市番禺区中心医院肾内科，主要从事肾移植研究。shavey@tom.com

Comparison of the incidence of infection and acute rejection in different anti-rejection treatment after renal transplantation

Huang Xiao-wei1, Liu Zhou2, Xie Min-yan1   

  1. 1Department of Nephrology, Central Hospital of Guangzhou Panyu District, Guangzhou  511400, Guangdong Province, China; 2the 458 Hospital of Chinese PLA, Guangzhou  510602, Guangdong Province, China
  • Received:2011-11-28 Revised:2011-12-16 Online:2012-04-29 Published:2012-04-29
  • Contact: Liu Zhou, Doctor, Chief physician, the 458 Hospital of Chinese PLA, Guangzhou 510602, Guangdong Province, China
  • About author:Huang Xiao-wei★, Master, Attending physician, Central Hospital of Guangzhou Panyu District, Guangzhou 511400, Guangdong Province, China shavey@tom.com

PDF

488

被引次数

5

摘要：

背景：目前对肾移植围手术期采用何种免疫抑制治疗方案(特别是抗体的使用)既可以减少急性排斥反应，又不增加受体感染的风险尚无统一的认识。
目的：比较肾移植后6个月内6种不同免疫抑制诱导治疗方案的感染及急性排斥发生率差异。
方法：采用前瞻性队列研究设计，将113例同种异体肾移植后患者分为甲基泼尼龙组、甲基泼尼龙+抗人T细胞免疫球蛋白组、甲基泼尼龙+抗胸腺细胞球蛋白组、甲基泼尼龙+赛尼哌组、甲基泼尼龙+抗胸腺细胞球蛋白+赛尼哌组、甲基泼尼龙+抗人T细胞免疫球蛋白+赛尼哌组，各组免疫抑制诱导治疗后均联合环孢素A+吗替麦考酚酯+泼尼松三联维持免疫抑制治疗。
结果与结论：①感染发生率：甲基泼尼龙+抗胸腺细胞球蛋白组最低，甲基泼尼龙+抗胸腺细胞球蛋白+赛尼哌组最高。各组间差异无显著性意义。②急性排斥发生率：甲基泼尼龙组最高，甲基泼尼龙+抗胸腺细胞球蛋白+赛尼哌组最低。甲基泼尼龙组明显高于甲基泼尼龙+抗胸腺细胞球蛋白+赛尼哌组及甲基泼尼龙+抗人T细胞免疫球蛋白+赛尼哌组(P < 0.05)。表明联合单克隆与多克隆抗体免疫抑制诱导治疗方案与单用甲基泼尼龙组或单独使用单克隆或多克隆抗体治疗组比较，不增加感染的发生，且急性排斥反应发生率较低。

关键词: 急性排斥反应, 肾移植, 感染, 免疫抑制治疗, 器官移植

Abstract:

BACKGROUND: At present, there is no unified opinion about which immunosuppressive agent (especially the antibodies) at the peri-operative period of renal transplantation can reduce the incidence of acute rejection and not increase the risk of serious infection of patients.
OBJECTIVE: To compare the differences of the infection and acute rejection rate in six different immunosuppressive induction therapies for 6 months after renal transplantation. 
METHODS: In this prospective cohort study, 113 patients who received allogeneic kidney transplantation were divided into methylprednisolone (MP) group (n=29), MP+anti-human T lymphocyte glubin (ALG) group (n=17), MP+anti-thymocyte globulin (ATG) group (n=8), MP+daclizumab group (n=12), MP+ATG+daclizumab group (n=30), MP+ALG+daclizumab group (n=17). All groups were followed by the cyclosporin+mycophenolate mofetil+prednisone triple maintenance therapy after induced with immunosuppression treatment.
RESULTS AND CONCLUSIONS: ①The incidence of infection was lowest in MP+ATG group and highest in MP+ALG group. There was no significant difference among the groups. ②The incidence of acute rejection was highest in MP group and lowest in MP+ATG+daclizumab group. And the incidence of acute rejection in MP group was significantly higher than that in the MP+ATG+daclizumab group and MP+ALG+daclizumab group (P < 0.05). It is concluded that the incidence of acute rejection was lower in patients receiving combination induction of immunosuppressive therapy with both monoclonal and polyclonal antibodies, and the incidence of infection was not increased compared to treatment with MP, monoclonal or polyclonal antibody alone.

中图分类号: