静脉注射人免疫球蛋白治疗肾移植后急性体液性排斥反应

Intravenous immunoglobulin therapy for acute humoral rejection of kidney transplants

目的探讨静脉注射人免疫球蛋白（IVIG）治疗肾移植术后急性体液性排斥反应（AHR）的临床效果。方法行尸体。肾移植者252例，其中16例（6．3％，16／252）发生AHR，其移植肾Banff分级分别为Ⅰ级3例，Ⅱ级9例，Ⅲ级4例。患者均采用他克莫司、霉酚酸酯及糖皮质激素预防排斥反应。采用WIG治疗以逆转AHR，用量为20g／d，连用3d。术后1个月内发生AHR的12例因移植肾功能恢复延迟，进行血液透析，其中1例加用血浆置换治疗。观察AHR的逆转情况及受者体液免疫和细胞免疫的变化。结果13例的AHR获得逆转，3例的移植肾功能丧失，行移植肾切除。治疗后，患者的抗HLA-Ⅰ类、Ⅱ类抗体水平下降不明显（P〉0．05）；IgG水平明显上升，由（7．3±1．5）g／L升至（18．3±3．6）g／L（P〈0．01）；补体C3和C4水平分别为（0．3±0．2）g／L和（0．1±0．1）g／L，较治疗前显著降低（P〈0．01）。IVIG治疗过程中，2例患者出现胸闷及体温升高，对症治疗后好转，患者治疗前后的肝功能均无显著变化。结论WIG对肾移植术后AHR的早期治疗有一定的效果，其机制可能与抗体封闭及对患者的体液免疫和细胞免疫的调节有关。

Objective To explore the clinical effectiveness intravenous immunoglobulin therapy for kidney transplant recipients with acute humoral rejection of the clinical effects. Methods From January 2005 to December 2007, 252 cases received kidney transplantation, and according to the standard of Banff,there were 16 cases of acute humoral rejection （3 cases of grade Ⅰ ,9 cases of grade Ⅱ ,and 4 cases of grade Ⅲ）. Taerolimus, mycophenolate mofetil and corticosteroids were used to prevent rejection. 16 AHR patients were treated with intravenous immunoglobulin（IVIG） treatment, 20 g/d for 3 d. 12 patients whose AHR occurred withing l month delayed graft function, so they had hemodialysis transition,amd 1 case of them had plasma exchange treatment. The reversal of AHR and the changes in humoral and cellular immunity of recipients were observed. Results 13 cases was reversed and 3 cases had nephrectomy. After treatment, the differents of reduction level in HLA- Ⅰ and HLA- Ⅱ antibody was not obvious（P〉0. 05）. The IgG level was increased from （7. 3 ±1.5）g/L to （18. 3±3.6）g/L, significantly（P〈0. 01 ）. After treatment, C3 and CA levels were reduced to （0. 3 ±0. 2）g/L and （0. 1 ±0.1 ） g/L, significantly （P〈 0. 01 ）. During treatment, 2 cases occurred chest discomfort and fever. Patients＇liver function had no significant difference after treatment. Conclusion IVIG in the early treatment of kidney transplant recipients with AHR had a certain effect, the mechanism might be antibody-blocked, as well as humoral and cellular immunity regulation in patients.