巴利昔单抗联合鼠抗人CD3单克隆抗体在高致敏受者肾移植中的临床应用  

Application of Basiliximab Combined with OKT3 in Hypersensitive Patients Receiving Renal Transplantation

作　　者：蔡文娥[1] 孙煦勇[1] 秦科[1] 聂峰[1] 赖彦华[1] 董建辉[1] 覃音红[1] 谭落娇 

机构地区：[1]解放军第303医院器官移植中心,南宁530021 [2]总参管理保障部北极寺老干部服务局门诊部,北京100191

出　　处：《中国药房》2012年第22期2075-2077,共3页China Pharmacy

摘　　要：目的:探讨巴利昔单抗与鼠抗人CD3单克隆抗体(OKT3)联合诱导在高致敏受者肾移植临床应用中的有效性及安全性。方法:术前2个月内群体反应性抗体(PRA)检测值均>50%的尸体供肾肾移植受者20例,其中9例受者接受巴利昔单抗联合OKT3免疫诱导(联合诱导组),11例受者接受OKT3常规免疫诱导(OKT3诱导组),均以他克莫司(Tac)+吗替麦考酚酯(MMF)+泼尼松(Pred)为基础免疫抑制方案,评估术后移植肾功能恢复情况、3个月内急性排斥反应发生率、1年内肺部感染发生率、1年人/肾存活率及移植肾功能。结果:联合诱导组、OKT3诱导组肾移植术后3个月内急性排斥反应发生率及术后1年内肺部感染发生率分别为11.1%vs.36.4%(P=0.319),11.1%vs.63.6%(P=0.028);联合诱导组患者术后1周内移植肾功能恢复正常比例明显高于OKT3诱导组(88.9%vs.27.3%,P=0.010);联合诱导组术后1年人/肾存活率均为100%,与OKT3诱导组(分别为90.9%、81.8%)比较,差异不显著(P=1.00和P=0.100);术后1年联合诱导组、OKT3诱导组血肌酐值分别为(105±24)、(97±22)μmol·L-1(P=0.437)。结论:巴利昔单抗联合OKT3进行免疫诱导,在预防高致敏受者术后早期排斥反应的同时,缩短了移植肾功能的恢复时间,是一种安全、有效的防治策略。OBJECTIVE：To study the efficacy and safety of basiliximab combined with mouse CD3 monoclonal antibody （OKT3） in hypersensitive recipients underwent renal transplantation.METHODS：2 months before operation,20 cadaveric donor renal transplantations were performed in patients with high panel reactive antibodies （PRA levels 〉50%）.All patients received basic immunosuppression therapy with Tac,MMF,and Pred.9 patients received prophylactic basiliximab combined with OKT3 （combined induction group）,and 11 received standard-dose OKT3 （OKT3 induction group）.The recovery of transplanted kidney function after operation,the incidence of acute rejection within 3 months,pulmonary infection and survival rate of human/kidney and renal transplantation function 1 year after operation were all evaluated.RESULTS：The incidence of acute rejection episodes of combined induction group vs.OKT3 induction group were 11.1% vs.36.4% （P=0.319）,and the incidence of pulmonary infection in both groups were 11.1% vs.63.6% （P=0.028）;the proportion of renal function returned normal in combined induction group within 1 week were significantly higher than in OKT3 induction group （88.9% vs.27.3%,P=0.010）.The survival rate of human/kidney 1 year after operation reached 100% in combined induction group,there was no significant difference between combined induction group and OKT3 induction group （90.9%,81.8%,P=1.00,P=0.100）.The serum creatinine of combined induction group and OKT3 induction group were （105±24）μmol·L-1 and （97±22）μmol·L-1（P=0.437） 1 year after operation.CONCLUSION：The combined use of prophylactic basiliximab and OKT3 can prevent rejection in the early stage,shorten the duration of renal function recovery and seems to offer a safe and effective strategy for induction therapy in hypersensitive patients receiving renal transplantation.

关 键 词：肾移植 高致敏受者 急性排斥反应 巴利昔单抗 鼠抗人CD3单克隆抗体 

分 类 号：R699.2[医药卫生—泌尿科学] R979.5[医药卫生—外科学]