单剂赛尼哌联合小剂量抗胸腺免疫球蛋白在肾移植免疫诱导中的应用  

Immunosuppression induction with single dose Zenapax and minidose antithymocyte globulin in kidney transplantation

作　　者：罗道升[1] 米其武[1] 潘光辉[2] 

机构地区：[1]东莞市人民医院泌尿外科,广东省东莞市523018 [2]广州医学院第二附属医院器官移植科,广东省广州市510260

出　　处：《中国组织工程研究与临床康复》2009年第31期6027-6030,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：为评估赛尼哌联合抗胸腺免疫球蛋白在肾移植术后预防急性排斥的临床价值,探讨肾移植后安全有效的免疫诱导方案,选择2000-01/2007-06东莞市人民医院及广州医学院第二附属医院器官移植中心肾移植患者556例,121例在应用三联免疫抑制方案同时,应用赛尼哌联合抗胸腺免疫球蛋白免疫诱导,其中89例属高危人群;435例应用常规三联免疫抑制方案。赛尼哌为单剂50mg,术前2h静脉滴注;抗胸腺免疫球蛋白共5剂500mg,分7d静脉给药,手术当天及术后第一二天各100mg,第3～6天各50mg;常规组三联免疫抑制方案为霉酚酸酯1000～1500mg/d,他克莫司0.1～0.2mg/(kg·d)或环孢菌素A5～6mg/(kg·d),泼尼松30mg/d;赛尼哌+抗胸腺免疫球蛋白组减量:霉酚酸酯500～1000mg/d,他克莫司0.05～0.1mg/(kg·d)或环孢素A4.0～5.0mg/(kg·d);常规组甲基强的松龙用法为术中及术后1～3d每天各500mg,赛尼哌+抗胸腺免疫球蛋白组冠状动脉粥样硬化性心脏病患者术中及术后1～3d各250mg。赛尼哌+抗胸腺免疫球蛋白组10例发生急性排斥反应,逆转9例,逆转率为90%;常规组急性排斥反应发生率为21%,逆转率为85%。赛尼哌+抗胸腺免疫球蛋白组术后感染9例,感染率为7%,常规组感染率为7%。赛尼哌+抗胸腺免疫球蛋白组死亡2例(2%),均为冠脉搭桥术后患者,常规组死亡4例(1%)。提示单剂赛尼哌联合短疗程抗胸腺免疫球蛋白在肾移植免疫诱导中的应用是安全有效的,尤其对高危人群具有更重要的临床价值。In order to evaluate the clinical efficacy of Zenapax combined with antithymocyte globulin （ATG） on preventing acute rejection after kidney transplantation and to explore a safe and efficient immunosuppression induction method, we reviewed 556 cases of kidney transplantation between January 2000 and June 2007, which were selected from Dongguan People＇s Hospital and the Second Affiliated Hospital of Guangzhou Medical College. Among all the 556 patients, 121 ones （with 89 high risk ones） were treated with Zenapax combined with ATG, together with the trigeminy immunosuppression plan; the other 435 patients were treated with the routine trigeminy immunosuppression plan. Single dose Zenapax of 50 mg was given to the patients by intravenous drip at 2 hours before transplantation. ATG of 5 doses, 500 mg in total, were given intravenously within 7 days, with 100 mg per day on the operation day, day 1 and day 2 following operation, 50 mg per day from day 3 to day 6 following operation. For the routine group treated with trigeminy immunosuppression plan （the routine group）, Mycophenolate Mofetil of 1 000-1 500 mg/d, Tacrolimus of 0.1 0.2 mg/（kg · d） or Cyclosporin A 5-6 mg/（kg · d） and prednisone of 30 mg/d were used. For the group treated with Zenapax combined with ATG （the ＂Zenapax＋ATG＂ group）, these doses were decreased as follows： 500-1 000 mg/d for Mycophenolate Mofetil, 0.05 0.1 mg/（kg · d） for Tacrolimus or 4.0 5.0 mg/（kg · d） for Cyclosporin A. In the routine group, medaron was used with 500 mg per day on the operation day and the days between day 1 and day 3 following operation; while in the ＂Zenapax＋ATG＂ group, it is used for patients with coronary atherosclerotic heart disease on the same days, but with a dose of 250 mg per day. Acute rejection occurred to 10 patients in the ＂Zenapax＋ATG＂ group, and 9 of them recovered with a recovery rate of 90%; while in the routine group, it occurred at a rate of 21%, and the recovery rate was 85%. Nine patients were i

关 键 词：肾移植 免疫诱导 急性排斥 赛尼哌 抗胸腺免疫球蛋白 

分 类 号：R617[医药卫生—外科学]