肾移植术后应用抗胸腺细胞球蛋白的价值与前景(64例次随访分析)  

APPLICATION OF ATG IN PATIENTS WITH RENAL TRANSPLANTATION

作　　者：任吉忠[1] 闵志廉[1] 朱有华[1] 何长民[1] 齐隽[1] 孟钢[1] 王卓伟[1] 王立明[1] 郑军华[1] 徐丹枫[1] 王亚伟[1] 周梅生[1] 徐建伟[1] 余加仁[1] 贺宗理[1] 

机构地区：[1]解放军泌尿外科中心第二军医大学长征医院肾移植中心

出　　处：《肾脏病与透析肾移植杂志》1997年第4期340-342,共3页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的：探讨抗胸腺细胞球蛋白（ＡＴＧ），在肾移植术后的应用价值与前景。方法：对６４例次使用ＡＴＧ的肾移植受者进行回顾性分析，比较其①对急性排异反应（ＡＲ）、急性加速性排异反应（ＡＡＲ）、超急性排异反应（ＨＡＲ）的预防与治疗情况；②对部分肾移植术后因各种原因暂不能使用常规免疫抑制剂者的替代与过渡治疗情况；③获得以上各种情况的治疗总剂量与总时限。结果：①ＡＴＧ对肾移植术后ＡＲ的逆转率为８２．３５％（１４／１７），对耐激素性ＡＲ的逆转率为７８．５７％（１１／１４），对ＡＡＲ的逆转率为１００％（１０／１０）；②ＡＴＧ制品适用于肾移植术后因各种原因暂不能服用常规免疫抑制剂者的替代与过渡治疗；③ＡＴＧ对ＨＡＲ不能起到预防与治疗的作用；④抗ＡＲ的ＡＴＧ治疗总剂量与时限以８００ｍｇ、５天为宜，抗ＡＡＲ的ＡＴＧ治疗总剂量与时限以７００ｍｇ、６天为宜，预防与替代治疗的总剂量与时限以７００ｍｇ、６天为宜。结论：ＡＴＧ适用于肾移植术后ＡＲ与ＡＡＲ的预防与治疗，特别对耐激素性排异反应以及暂时的替代与过渡治疗尤为合适，如果经济状况允许，应提倡使用。OBJECTIVE To evaluated the efficacy of anti thymocyte globulin (ATG) in renal graft rejection. METHODOLOGY Data of 64 administration of ATG in renal graft recipients were studied retrospectively, including 17 in patients with acute rejection(AR), 10 for acute accelerated rejection(AAR), 2 for hyperacute rejection(HAR) and 35 for preventing therapy alternatively. RESULTS The reverse rate of rejection was 82 35%(14/17) in AR, 78 57%(11/14) in steroid resistant AR, 100%(10/10) in AAR and 0%(0/2) in HAR. In patients taking ATG for prophylaxis, HAR occurred in 6 07%(2/33), AR in 0%(0/33), AAR in 3 03%(1/33), while in patients alternative preventing therapy no AR or HAR were observed(0/2, 0/2). CONCLUSION ATG is very effective in preventing and reversing of AR, AAR, especially steroid resistant AR, while it is in effective in the prevention of HAR. The recommended dosage is 800 mg×5 days for AR, 750 mg×6 days for AAR and 200 mg×6 days for prophylactic and replaceable usage.

关 键 词：肾移植 排异反应 抗胸腺细胞 球蛋白 

分 类 号：R699.2[医药卫生—泌尿科学] R977.6[医药卫生—外科学]