OKT3在肾移植术后急性排斥反应防治中的应用

Application of OKT3 in the Prevention and Treatment of Acute Rejection for Kidney Recipients

目的探讨应用抗淋巴细胞单克隆抗体OKT3预防及治疗肾移植术后急性排斥反应(AR)的效果和安全性、副反应等.方法对照组128例肾移植患者,术后常规应用甲基泼尼松龙(MP)、强的松(Pred)、硫唑嘌呤(Aza)、骁悉/布累迪宁和环孢素A(CsA)、普乐可复(FK506);实验组36例在上述用药的基础上,术后前10d连续应用OKT310mg,使用前以MP200mg诱导.结果实验组AR发生时间较对照组明显推迟,其AR发生率明显降低(χ2=4.725,P<0.05).6例耐激素性急性排斥反应(SR-AR)应用OKT3治疗,4例逆转,逆转率为66.7%.结论 OKT3作为肾移植术后的预防用药,能减少AR的发生率,并能降低排斥反应的强度,可提高移植肾长期存活率.OKT3作为肾移植AR的治疗用药,能较好的逆转SR-AR反应.可使一部分患者避免因AR丧失移植肾.OKT3进入人体能引起首剂综合症等很多副反应,应当引起重视.

ObjectiveTo investigate the effect and reliability of using OKT_3 to prevent and treat post-operative acute rejections in kidney recipients.MethodsMethylprednisolone, prednisolone, mycophenolate mofetil, and cyclosporine A were routinely used in the control group(128 recipients).OKT_3(5?mg/d)was administered intravenously in the Experimental Group(36 recipients)for the first 10?d after operation, in addition to above drugs used in control group.ResultsIn the experimental group, the incidence of AR and the intensity of AR were much lower than that of the control group. The difference between two groups was obvious(χ~2=(4.725),P<(0.05)).ConclusionOKT_3 can reduce the incidence of AR, lower the intensity of AR, enhance the reversion rate of therapy by MP and long-term survival rate of graft. As the therapeutic medicine to AR after transplantation, OKT_3 can reverse SR-AR very well. It can rescue some of patients from losing graft as a result of AR. As a kind of foreign protein, OKT_3 can lead to many side effects, attention should be aroused.