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目的评估肾移植受者中应用两种不同生物制剂进行免疫诱导治疗的疗效和安全性。方法回顾性分析2008年6月至2013年4月,在解放军第452医院泌尿外科暨成都军区泌尿外科中心应用生物制剂进行免疫诱导治疗的78例尸体肾移植受者的临床资料。根据应用免疫诱导方案不同分为两组,单克隆抗体组(A组,35例,接受巴利昔单抗治疗)和多克隆抗体组[B组,43例,接受抗胸腺细胞球蛋白(ATG)治疗]。另以同期在该院未接受免疫诱导治疗的肾移植受者作为对照组(C组,32例)。分析3组受者术后12周内的人、肾存活情况。监测3组受者术后7、14、30、60 d血清肌酐(Scr)水平变化。比较3组受者急性排斥反应、移植肾功能延迟恢复、感染等并发症的发生率。结果术后12周,3组受体人、肾存活率分别为A组100%和100%,B组97.7%和97.7%,C组100%和96.9%,各组间比较差异无统计学意义(均为P>0.05)。术后7、14 d,与C组比较,A组和B组的Scr水平明显下降,差异均有统计学意义(均为P<0.05)。与C组比较,A、B两组受者急性排斥反应发生率均降低,差异有统计学意义(均为P<0.05);3组受者移植肾功能延迟恢复发生率比较,差异无统计学意义(均为P>0.05)。B组受者术后感染发生率高于A组和C组,差异均有统计学意义(均为P<0.05)。结论免疫诱导治疗在肾移植受者中应用安全有效。
Objective To evaluate the efficacy and safety of two different biological agents for immune induction in renal transplant recipients. Methods The clinical data of 78 cases of cadaver kidney transplant recipients who were immunized with biologic agents during the period of June 2008 to April 2013 in Department of Urology, 452 Hospital of PLA and Chengdu Military Region Urology Center were retrospectively analyzed. According to the different application of immune induction program, the patients were divided into two groups: monoclonal antibody group (group A, 35 patients treated with basiliximab) and polyclonal antibody group (group B, 43 patients receiving anti-thymocyte globulin )treatment]. The same period in the same hospital did not receive immunotherapy induced renal transplant recipients as a control group (C group, 32 cases). Three groups of recipients were analyzed for survival within 12 weeks after surgery. Serum creatinine (Scr) levels were monitored at 7, 14, 30 and 60 days after operation in 3 groups. The incidence of complications such as acute rejection, delayed graft function recovery and infection were compared between the three groups. Results After 12 weeks of operation, the survival rates of three groups of recipients were 100% and 100% in group A, 97.7% and 97.7% in group B, 100% and 96.9% in group C, respectively, with no significant difference between groups (All P> 0.05). At 7 and 14 days after operation, compared with group C, the levels of Scr in group A and group B were significantly decreased (all P <0.05). Compared with group C, the incidence of acute rejection in both A and B recipients decreased, with statistical significance (all P <0.05). There was no significant difference in the delayed recovery of graft function between the three groups Significance (all P> 0.05). The incidence of postoperative infection in group B was higher than that in group A and C (all P <0.05). Conclusion Immune induction therapy is safe and effective in renal transplant recipients.