使用抗淋巴制剂治疗难治性排斥反应的临床观察

The clinical effect of ATG and OKT3 on the treatment of refractory rejection after cadavaric kidney transplantation

目的观察抗胸腺细胞球蛋白（ＡＴＧ）和单克隆抗体ＣＤ３（ＯＫＴ３）对难治性排斥反应的疗效。方法８７例患者，其中ＡＴＧ组１３例，平均治疗总量１０００ｍｇ；ＯＫＴ３组７４例，平均治疗总量４５ｍｇ。结果ＡＴＧ组对急性加速性排斥反应治愈２例；对急性排斥反应治愈７例；总有效率为６９２３％（９／１３）。ＯＫＴ３组对急性加速性排斥反应治愈率为９０００％（２７／３０）；对急性排斥反应治愈率为９０４７％（３８／４２）；总有效率为９０２８％（６５／７２）与ＡＴＧ组有显著性差异（Ｐ＜００５）。其中对再次移植患者的各种急性排斥反应有效率为９１６７％（１１／１２）。结论ＯＫＴ３治疗难治性排斥反应的效果优于ＡＴＧ，尤其对再次移植患者。

Objective To observe the effect of ATG and OKT3 on the treatment of refractory rejection, including acute and chronic rejection after cadaveric kidney transplantation. Method 87 patients with refractory rejection after cadaveric kidney transplantation were treated by using ATG (13 patients) and OKT3 (74). A total dose of 1000 mg for ATG group or 45 mg for OKT3 group was administered for each patient. Result Two accelerating rejection and acute rejection were reversed and 7 in the ATG group, 9000% (27/30) and 9047% (38/42) in the OKT3 group respectively. A significant difference of total reverse rates was seen between the ATG and OKT3 groups (6923% verse 9028%, P<005). In retransplant patients, the reverse rate of acute rejection by OKT3 was 9167% (11/12). But OKT3 did not show any effect in patients with chronic rejection. Conclusion OKT3 is better than ATG for reversing the refractory rejection, especially in retransplant patients, but it has no any effect on chronic rejection.