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背景:很多方法可降低群体反应抗体致敏患者的群体反应抗体水平,其中血浆置换或免疫吸附法脱敏法是比较常用的,但这些方法副作用较多。目的:拟观察肾移植前静脉滴注免疫球蛋白对肾移植患者血清群体反应抗体的影响。设计、时间及地点:以2003-01/2006-11重庆医科大学附属第一医院肾移植中心的57例等待肾移植的群体反应抗体致敏患者为对象的前后对照,病例分析。对象:群体反应抗体致敏患者57例,年龄21～65岁,群体反应抗体值平均(46.7±29.5)%。方法:所有患者在接受肾移植前以5g/d剂量静脉滴注免疫球蛋白,2周为1个疗程。2个疗程之间间隔1周。在给予静脉滴注免疫球蛋白前和疗程结束立即应用酶联免疫吸附反应方法各检测1次血清群体反应抗体水平。主要观察指标:血清群体反应抗体水平。结果:应用免疫球蛋白后群体反应抗体降为非致敏84%(48/57),完全未降5%(3/57),部分下降11%(6/57)。用药后群体反应抗体下降0～61%,平均(38.4±16.3)%。57例患者肾脏移植前淋巴细胞毒试验<10%,均未出现超急性排斥反应。结论:静脉滴注免疫球蛋白预治疗是理想的降低肾移植致敏性的方法,且副作用小。
BACKGROUND: There are many ways to reduce the level of antibody response in patients who are sensitized by population-responsive antibodies. Plasma exchange or immunoadsorption desensitization methods are more common, but these methods have more side effects. Objective: To observe the effect of intravenous immunoglobulin infusion before kidney transplantation on serum antibody in renal transplant recipients. DESIGN, TIME AND SETTING: A retrospective and case-control study was conducted on 57 patients who were sensitized by a population of antibody-reactive to kidney transplant recipients from January 2003 to November 2006 in the First Affiliated Hospital of Chongqing Medical University. PARTICIPANTS: 57 patients (aged 21-65 years old) with population-responsive antibody sensitization were averaged (46.7 ± 29.5)% of the population. METHODS: All patients received an IV infusion of immunoglobulin at a dose of 5 g / d prior to renal transplantation for 2 weeks as a course of treatment. 2 courses between the interval of 1 week. Serum group antibody levels were detected by enzyme-linked immunosorbent assay immediately before intravenous immunoglobulin infusion and at the end of treatment. MAIN OUTCOME MEASURES: Serum population reactive antibody levels. Results: After immunoglobulin immunization, the population of antibody was reduced to 84% (48/57) in non-sensitized group. The antibody did not decrease by 5% (3/57) and partly declined by 11% (6/57). Antibody response decreased by 0 ~ 61%, with an average of (38.4 ± 16.3)%. Fifty-seven patients had <10% lymphocytotoxicity before kidney transplantation, and no hyperacute rejection occurred. Conclusion: Intravenous immunoglobulin pretreatment is an ideal method to reduce the sensitization of renal transplantation, and the side effects are small.