赛尼哌在肾移植后长期疗效作用的临床观察

Long-term therapeutic effect of Zenapax after renal transplantation

目的了解2剂赛尼哌治疗方案能够在1个月内完全阻断白细胞介素2受体（IL-2R），减少T细胞增殖，停用赛尼哌后是否还存在延续作用，除了IL-2R被阻断这个途径外是否还存在其他途径来调节免疫。方法对15例常规免疫抑制三联疗法（对照组）以及15例使用2剂赛尼哌诱导治疗（诱导组）的同种异体肾移植患者均随访6个月，每个患者均在术前2h，术后1个月，术后3个月以及术后6个月检查IL-2，IL-10，STAT5以及CD40L水平。结果术前2h、术后1个月、3个月以及6个月的IL-2，STAT5水平，诱导组和对照组间差异无统计学意义。IL-10水平在术后3个月时诱导组（59．4±7．7）ng／L明显高于对照组（36．8±8．4）ng／L。CD40L水平在术后1个月时诱导组（10．6±3．6）明显低于对照组（35．6±8．4）。结论赛尼哌能够在术后1个月时通过抑制CD40L水平来减少B细胞介导的体液免疫反应的发生。

Objective To determine whether there was any lingering effect after discontinuing Zenapax in renal transplantation and investigate there was any alternative immunity-regulating pathway of Zenapax other than IL-2/IL-2R. Methods Thirty patients of renal transplantation were divided into 2 groups. One group of 15 received 2 dosages of induction therapy of Zenapax and another 15 regular immunosuppressive therapy. IL-2, IL-10, STAT5 and CD40L were tested followed up at 2 hours pre- transplantation, 1, 3 and 6 months post-transplantation. Results The levels of IL-2 and STAT had no difference between the induction group and the control group. The level of IL-10 of induction group（59. 4 ± 7.7 ） ng/L was obviously higher than control group （ 36. 8 ± 8.4 ） ng/L at 3 months post-transplantation. CD40L level of induction group （ 10. 6 ± 3.6 ） was lower than control group （ 35.6 ± 8. 4 ） at 1 month posttransplantation. Conclusion Zenapax can reduce B-cell-mediated humoral immunity at 1 month posttransplantation through CD40L pathway.