赛尼哌预防肾移植急性排斥反应的临床观察

Clinical observation of effect of Zenapax on prevention of acute rejection after kidney transplantation

目的探讨赛尼哌(Zenapax)在预防肾脏移植急性排斥反应的临床效果及其安全性。方法选择2002年～2005年5月接受尸体肾移植88例,术前HLA氨基酸残基配型均为2MM错配,淋巴毒交叉配型阴性。其中群体反应抗体阳性受者为A组(n=28),其余随机分为赛尼哌治疗组B组(n=30)和对照组C组(n=30),A和B组赛尼哌用单剂50mg诱导治疗,手术前2h静脉给药。所有受者在围手术期和术后均采用同样"三联"免疫抑制方案。结果3组之间的年龄、性别、ABO血型分布、供肾冷热缺血时间差异无显著性。急性排斥反应诊断标准依据临床表现,生化检验,超声波检查,肾移植术后3个月内,A组急性排斥发生率为14.3%(n=4),B组急性排斥发生率为6.7%(n=2),C组急性排斥发生率为16.7%(n=5)。使用赛尼哌B组急性排斥发生率明显低于不用赛尼哌组(P<0.05),并且赛尼哌组需要接受抗淋巴细胞球蛋白(ALG)治疗的患者少于不用赛尼哌组,胃肠道反应、血液系统的损害及感染发生率等方面差异无显著性。结论通过临床观察赛尼哌可减少急性排斥反应的发生率而不增加总体免疫抑制剂的副作用和感染的并发症,对于PRA阳性受者只要避免致敏的抗体,其治疗效果仍然是良好的。

[Objective] To observe the effect and security of Zenapax on prevention of acute rejection after kidney transplantation. [Methods] 88 cases of cadaveric renal transplantation from 2002 to May 2005 were chosen. In them, HLA zygosity showed 2MM mismatch, cross-zygosity showed negative. All of the cases were divided into group A （PRA positive, n=28）, group B （negative, n =30） and control group（n =30）. Groups A and B were administered derivation treatment of 50 mg Zenapax 2 hours before operation. All the cases received the same immunotherapy in preoperative and postoperative periods. [Results] Acute rejection rate was 14.3% in group A（n =4）, 6.7% in group B （n=2） and 16.7% in group C （n =5）. Acute rejection rate was significantly lower in group B than that in the control group（P 〈0.05）. There was insignificant difference in infection and side effects between both groups. [Conclusion] It is effective and secure to use single dosage Zenapax for the prevention of acute rejection after renal tranplantation.