小剂量兔抗人胸腺细胞免疫球蛋白与抗人T细胞猪免疫球蛋白在肾移植诱导治疗中的比较  

Comparison of low dose thymoglobulin and ALG-P in the induction therapy for kidney transplant recipients

作　　者：冯小芳[1] 闵敏[1] 左富姐[1] 周梅生[2] 王立明[2] 

机构地区：[1]上海市闸北区中心医院(长征医院闸北分院)肾移植康复科,上海200070 [2]上海长征医院器官移植中心

出　　处：《肾脏病与透析肾移植杂志》2012年第6期530-535,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:比较小剂量兔抗人胸腺细胞免疫球蛋白(即复宁)与抗人T细胞猪免疫球蛋白(ALG-P)在肾移植诱导治疗中的效果。方法:将120例首次肾移植受者随机分为小剂量即复宁组(44例)、ALG-P组(36例)和对照组(40例)。随访1年后比较三组血白细胞、血小板、外周血T淋巴细胞绝对值、肾功能恢复程度、过敏反应发生情况、继发感染与急性排斥发生率和肾功能延迟恢复(DGF)发生率等。结果:小剂量即复宁组、ALG-P组与对照组相比,外周血T淋巴细胞绝对值下降更明显,尤其是CD4+T淋巴细胞,在术后3d、9d、1月、3月、6月均能明显下降(P<0.05);同时急性排斥反应发生时间延迟,1周内无急性排斥反应发生,急性排斥反应及DGF发生率更低(P<0.05),肾功能恢复情况更好(P<0.05);虽过敏反应及血小板严重下降增多(P<0.05),但并未导致严重后果。小剂量即复宁组患者在肾移植术后早期(术后3月内)外周血T淋巴细胞绝对值较ALG-P组下降更明显,以CD4+T淋巴细胞为著(P<0.05);小剂量即复宁组急性排斥反应及DGF发生率更低,肾功能恢复情况更好;但两组患者继发感染、过敏反应、血小板和白细胞等严重下降的发生率无明显差异。结论:小剂量即复宁和ALG-P在肾移植免疫诱导治疗中使用是安全而有效的,小剂量即复宁效果更佳,可作为免疫抑制诱导治疗的更优选择。Objective：To evaluate the effects of low dose of thymoglobulin and ALG-P in the induction therapy for kidney transplant recipients. Methodology：One hundred twenty cases with first kidney transplant were randomly divided into 3 group：low dose of thymoglobulin group （n = 44） ;ALG-P group（ n = 36）and control group （n = 40）. Follow-up was 1 year. The peripheral T--lymphyote absolute counts, graft function recovery, allergic reaction, the rates of infection and acute rejection, the rates of delayed graft function （DGF）, and the change of leukocytes and platelets were statistically compared among the three groups. Results：The peripheral T-lymphyote absolute counts were decreased more significantly in ALG-P group and low dose of thymoglobulin group, especially CD4 ＋ T Lymphocyte, at third, 9th , 1,3, and 6 month postoperative, were decreased more significantly. Compare with control group, the delayed acute rejection and no acute rejection in one week, the rate of acute rejection and delayed graft function were more lower, graft function recovery were better, the rate of allergic reaction, the decrease of platelets were more significantly, but not leaded to severe consequence. Compare with ALG- P group,in low dose of Thymoglobulin group, the peripheral T-lymphyote absolute counts were decreased more significantly postoperative early （within three months after transplantation）, especially CD4 ＋T Lymphocyte, at third ,9th ,one and three month postoperative were decreased more significantly （P 〈 0. 05）. The rate of acute rejection and delayed graft function were more lower （ P 〈 0. 05 ）, graft function recovery was better, the rate of allergic reaction, and the decrease of leukocytes and platelets were no differences between two groups （ P 〉 0. 05）. Conclusion： ALG-P and low dose of Thymoglobulin are effective and safe in induction therapy for kidney transplant recipients which can be the optimal choice for inductiontherapy. Compare with ALG-P group, low dose of Thymoglobu

关 键 词：肾移植诱导治疗多克隆抗体 

分 类 号：R699[医药卫生—泌尿科学]