儿童肝移植受者围手术期CD25人源化单克隆抗体联合激素减量免疫诱导的疗效探讨  

Perioperative efficacy study of recombinant humanized anti-CD25 monoclonal antibody combined with steroid minimization for immunoinduction in pediatric liver transplant recipients

作　　者：习剑鑫 陈玉国[1] 耿笑辰 邱伟[1] 吕国悦[1] Xi Jianxin;Chen Yuguo;Geng Xiaochen;Qiu Wei;Lyu Guoyue(Department of Hepatobiliary and Pancreatic Surgery,General Surgery Center,First Hospital of Jilin University,Changchun,130000,China)

机构地区：[1]吉林大学第一医院普通外科中心肝胆胰外一科,长春130000

出　　处：《临床小儿外科杂志》2025年第3期207-214,共8页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(82241223,U20A20360)。

摘　　要：目的观察重组抗白细胞分化抗原25(cluster of differentiation 25,CD25)人源化单克隆抗体联合激素减量免疫诱导方案预防儿童肝移植受者急性排斥反应(acute rejection,AR)的效果。方法回顾性分析2015年7月至2024年8月于吉林大学第一医院接受肝移植的79例儿童受者资料,根据围手术期免疫诱导方案分为全量激素组60例、CD25单抗联合半量激素组19例。全量激素组围手术期采用全量激素诱导,术后采用他克莫司联合激素免疫抑制;CD25单抗联合半量激素组围手术期采用重组抗CD25人源化单克隆抗体联合半量激素诱导,术后单用他克莫司免疫抑制。对比两组术后AR、感染及激素相关并发症等主要结局,以及重症监护室(intensive care unit,ICU)停留时间、移植物存活率、患者存活率、住院时间及住院花费等次要结局的差异。结果CD25单抗联合半量激素组与全量激素组相比,术后AR发生率(4/19比16/60)、感染发生率(12/19比40/60)、激素相关并发症发生率(11/19比24/60)、排斥反应发生时间差异无统计学意义(P>0.05),ICU停留时间、住院花费、移植物存活率(18/19比59/60)、患者存活率(19/19比54/60)差异无统计学意义(P>0.05),但两组住院时间差异有统计学意义(P<0.05)。结论重组抗CD25人源化单克隆抗体联合激素减量免疫诱导方案安全有效,能够在减少激素用量的同时实现相似的免疫抑制效果,但与全量激素诱导相比,并不能降低AR、感染及激素相关并发症的发生率。Objective To observe the efficacy of recombinant anti-cluster of differentiation 25(CD25)humanized monoclonal antibody plus steroid reduction immune induction regimen in preventing acute rejection(AR)in pediatric liver transplant(LT)recipients.Methods Retrospective analysis was conducted for 79 pediatric LT recipients between July 2015 and August 2024.Based upon perioperative immune induction regimens,they were assigned into two groups of full-dose steroid(n=60)and CD25 monoclonal antibody combined with half-dose steroid(n=19).The former group received full-dose steroid induction perioperatively,followed by tacrolimus plus steroids for postoperative immunosuppression.And the latter group received recombinant anti-CD25 humanized monoclonal antibody plus half-dose steroid induction perioperatively,followed by tacrolimus monotherapy for postoperative immunosuppression.The incidence rates of postoperative AR,infection,steroid-related complications and other primary outcomes were compared between two groups.Secondary outcomes,including intensive care unit(ICU)stay,graft survival,patient survival,length of hospitalization stay and hospitalization expenses were also compared.Results The incidence of AR(4/19 vs.16/60),infection complications(12/19 vs.40/60)and steroid-related complications(11/19 vs.24/60)in CD25 monoclonal antibody combined with half-dose steroid group did not significantly differ from full-dose steroid group(P>0.05).Additionally,no significant inter-group differences existed in ICU stay,hospitalization expenses,graft survival rate(18/19 vs.59/60)or patient survival rate(19/19 vs.54/60)(P>0.05).However,length of hospitalization stay was significantly shorter in CD25 monoclonal antibody combined with half-dose steroid group than that in full-dose steroid group.Conclusions The recombinant anti-CD25 humanized monoclonal antibody plus steroid reduction immune induction regimen is both safe and effective,achieving similar immunosuppression with tapered steroid dosing.However,as compared with steroid group,it

关 键 词：肝移植 重组抗CD25人源化单克隆抗体 急性排斥反应 糖皮质激素 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]