抗白细胞介素2受体单克隆抗体在肝移植中的应用  

Application of anti-interleukin 2 receptor monoclonal antibody in liver transplant recipients

作　　者：葛旭鹏[1] Gunnar Soderdahl 吴国生[3] Grzegorz Nowak Bo-Goran Ericzon 

机构地区：[1]白求恩医科大学第一医院普外科,长春130021 [2]TransplantationDepartmentHuddingeHospital [3]第四军医大学附属西京医院胃肠外科

出　　处：《中华器官移植杂志》2003年第3期185-187,共3页Chinese Journal of Organ Transplantation

摘　　要：目的　探讨抗白细胞介素 2受体单克隆抗体 (抗IL 2R单克隆抗体 )的不同给药时间对肝移植后排斥反应的影响。方法　将 2 1例肝移植患者分为两组 ,均于手术当天及术后第 4d分别应用 2 0mg的抗IL 2R单克隆抗体 ,不同的是前 10例患者的首次剂量于移植肝恢复血流后给予 (术中组 ) ,而后 11例患者在移植术开始前 2h给予 (术前组 )。两个组术后均同时使用环孢素A和激素。术后随访 3个月。结果　经活检病理证实的急性排斥反应 ,术中组的发生率为 5 / 10 ( 5 0 % ) ,术前组为 3/ 11( 2 7% ) ;术中组还有 3例急性排斥反应未经病理证实 ,但抗排斥治疗有效 ,而术前组无类似病例 ,若综合考虑 ,则术前组急性排斥反应发生率 ( 3/ 11)明显低于术中组 ( 8/ 10 ,P <0 .0 5 )。在抗IL 2R单克隆抗体应用的过程中没有发现明显的不良反应。结论　术前 2h给予抗ILObjective To investigate the effect of anti interleukin 2 receptor monoclonal antibody (anti IL 2R Mab) administration at different time points on the rejection following liver transplantation. Methods Twenty one consecutive liver transplant patients were divided into two groups. There was no difference in patient's demographics and indications between the two groups. They all received 20 mg of anti IL 2R Mab on day 0 and day 4 in addition to CsA and steroids as induction therapy. The first 10 patients (Intraop.Group) received the first dose of anti IL 2R Mab immediately after the reperfusion of the implanted liver. While the latter 11 patients (Preop.Group) received the first dose of anti IL 2R Mab 2?h before the operation. Follow up was 3 months. Results No acute side effects were found during the admini stration of anti IL 2R Mab. The biopsy confirmed acute rejection episodes in the Intraop.Group was 5/10 (50%) versus 3/11 (27%) in the Preop.Group. There were three further cases of clinical rejection episodes in the Intraop.Group who had no biopsy performed due to logistic reasons. However, there were no such cases in the Preop.Group. If both biopsy confirmed and clinical rejection episodes were considered, the rejection episodes in the Preop.Group were significantly lower than in the Intraop.Group ( P = 0.03 ).Conclusion The application of anti IL 2R Mab in liver transplant patients was safe and well tolerated. There were less acute rejection episodes when the first dose of anti IL 2R Mab was given before operation than after reperfusion. The same dosing regimen in kidney transplant recipients appeared to be sufficient and effective in preventing the incidence of acute rejections also in liver transplant recipients.

关 键 词：肝移植术 抗白细胞介素2受体 单克隆抗体 给药时间 急性排斥反应 

分 类 号：R657.3[医药卫生—外科学] R392.4[医药卫生—临床医学]