肾移植后采用ATG与IL-2受体拮抗剂诱导治疗时并发感染的临床分析  

Clinical analysis of infection following ATG and IL-2 receptor antagonists-based induction therapy afterrenal transplantation

作　　者：马磷瞵[1] 解泽林[1] 唐雅望[1] 孙雯[1] 郭洪波[1] 林俊[1] 张磊[1] 田野[1] 

机构地区：[1]首都医科大学附属北京友谊医院泌尿科,北京100050

出　　处：《中华器官移植杂志》2012年第6期335-338,共4页Chinese Journal of Organ Transplantation

基　　金：国家重点基础研究发展计划（2009CB522401）

摘　　要：目的探讨肾移植后应用兔抗人胸腺细胞球蛋白（rATG）和白细胞介素2（IL-2）受体拈抗剂诱导治疗时并发感染的情况。方法回顾性分析2005年1月至2010年12月间701例肾移植受者的临床资料，去除其中移植后2周内因严重并发症死亡和移植肾切除的病例，以及未使用抗体类制剂诱导治疗的病例。符合纳入条件者549例，其中429例应用rATG（ATG组），120例应用IL-2受体拮抗剂（单抗组，使用巴利昔单抗者86例，使用达利珠单抗者34例）。以术后早期急性排斥反应发生率（临床诊断）作为诱导治疗有效性指标，在此基础上主要分析术后感染发生率、感染发生时间、治疗感染的住院时间、重症感染率和病死率等指标。两组术后均采用他克莫司（或环孢素A）＋吗替麦考酚酯＋泼尼松预防排斥反应，部分病例采用更昔洛韦＋联磺甲氧苄啶预防感染。结果ATG组的急性排斥反应发生率为15．9％（68／429），单抗组为10％（12／120），两组问差异无统计学意义（P〉0．05）。ATG组感染发生率为11．9％（51／429），其中13．7％（7／51）为重症感染，病死率为7．8％（4／51），住院治疗时间为25．8d；单抗组感染发生率为15．0％（18／120），其中11．1％（2／18）为重症感染，病死率为5．6％（1／18），住院治疗时间为19．1d，两组间感染发生率、重症感染率和病死率的差异均无统计学意义（P〉0．05），但单抗组住院治疗时间明显短于ATG组（P〈0．05）。死亡病例均未接受正规感染预防，且年龄超过50岁。结论两种诱导治疗存在同样的感染风险和感染死亡率，但使用IL-2受体拈抗剂者的感染相对容易控制，规范的感染预防措施是降低感染发生率和病死率的关键。Objective To investigate the infection following the lymphocytes deleted agent （ATG） and IL-2 receptor antagonists （Basiliximab and Daclizumab） based induction therapy after renal transplantation. Methods A retrospective analysis was carried out on 701 kidney transplant recipients between Jan. 1, 2005 to Dec. 31, 2010. According to exclusive and inclusive criteria, finally 549 patients were evaluated, including 429 patients treated with ATG （ATG group） and 120 patients with anti-CD25 monoclonal antibodies （monoclonal antibodies group; 86 patients with Basiliximab, and 34 patients with Daclizumab）. The incidence of acute rejection, infection rate, infection time, hospital stay, severe infection rate and mortality were analyzed. After operation, the patients received an immunosuppression therapy including Tacrolimus （ cyclosporine A ）, Mycophenolate-Mofetil and prednisone to present rejection. Part of the patients were treated with ganeiclovir and sulfamethoxazole sulfadiazine and trimethoprim for infection prevention. Results The acute rejection rate in ATG group and monoclonal antibodies group was 15.90/oo （68/429） and 10. 0% （12/120）, and there was no statistically significant difference （P〉0. 05）. The infection rate in ATG group was 11.9% （51/429）, including 13.70% （7/51） with severe infection, and mortality was 7. 8% （4/51）. The infection rate was 15. 0%（18/120） in monoclonal antibodies group, including 11.1% （2/18） with severe infection, and mortality was 5.6%（ 1/18）. There was no statistically significnat difference in infection rate, severe infection rate and mortality between two groups （P〉0. 05）. The hospital stay in ATG group and monoclonal antibodies group was 25.8 days and 19. 1 days respectively （P〈0. 05）. Dead cases had not received regular anti infection treatment, and the patients age wasover 50 years. Conclusion The infection risk and mortality between these two induction therapies are identical, but in comparison to the patient

关 键 词：肾移植 抗胸腺细胞球蛋白 巴利昔单抗 感染 

分 类 号：R392.12[医药卫生—免疫学]