南方医科大学学报

南方医科大学学报 ›› 2006, Vol. 26 ›› Issue (12): 1818-1820.

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单剂半量赛尼哌预防移植肾急性排斥的临床观察

朱云松； 徐安平； 何恢绪； 范礼佩； 聂海波； 吕军； 胡卫列； 李清荣； 邓志雄；   

  1. 广州军区广州总医院泌尿外科； 中山大学第二附属医院肾内科； 南方医科大学珠江医院肾移植科； 广州军区广州总医院泌尿外科 广东广州510010； 广东广州510120； 广东广州510010； 广东广州510282；
  • 出版日期:2006-12-20 发布日期:2006-12-20

Half-dose Zenapax for acute rejection prevention after renal transplantation

ZHU Yun-song1,XU An-ping2,HE Huei-xu1,FAN Li-pei3,NIE Hai-bo1,NV Juen1,HU Wei-nie1,LI Qing-rong1,DEN Zhi-xiong1 1Department of Urology,Guangzhou General Hospital of Guangzhou Command,Guangzhou 510010,China;2Department of Organ Transplantation,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;3Department of Renal Transplantation,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China   

  1. 广州军区广州总医院泌尿外科； 中山大学第二附属医院肾内科； 南方医科大学珠江医院肾移植科； 广州军区广州总医院泌尿外科 广东广州510010； 广东广州510120； 广东广州510010； 广东广州510282；
  • Online:2006-12-20 Published:2006-12-20

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摘要： 目的观察单剂半量赛尼哌对肾移植急性排斥(AR)的预防作用及安全性评估。方法选择同期肾移植病人187例,根据术后肾功能恢复情况及术前是否使用赛尼哌分为A/90例、B/73例、C/11例、D/13例4组,其中A、B组移植后肾功能恢复良好,即术后1周血肌酐<176.6μmol/L,C、D组术后出现移植肾功能延迟恢复,术后1周血血肌酐>353μmol/L。A、C两组术前2h静滴赛尼哌25mg(0.5mg/kg)和口服霉酚酸酯0.75g,B、D组仅口服霉酚酸酯0.75g;术后四组病人均予甲基强的松龙500mg×3d冲击,常规强的松、环孢霉素A和霉酚酸酯三联抗排斥治疗。观察术后6个月内AR发生率、发生时间、强度及排斥逆转率,同时观察胃肠道反应、感染及血液系统损害等副作用。结果A组13例(14.4%)发生AR,B组18例(24.6%),C组6例(54.5%),D组7例(53.8%),A组AR发生率明显低于B、C、D三组(P均<0.01);B组AR发生率显著低于C、D组(P<0.01),C、D组差异不显著(P>0.05),A组排斥开始时间3-9d(6.2±3.2d)较B组2-8d(4.5±3.1d)、C组2-7d(4.3±4.2d)、D组2-9d(3.9±3.5d)明显延迟(P均<0.05)。但B、C、D三组排斥开始时间无明显差异(P>0.05)。A组AR经强化治疗均逆转,B组16例逆转,另2例失败,C组5例逆转,1例因移植肾排斥破裂出血切除,D组5例逆转,2例失败;C、D组各2例于术后13-32d再次排斥,经甲基强的松龙强化治疗逆转。感染、胃肠道反应及血液系统损害四组差异不显著(P均>0.05)。结论移植后肾功能恢复良好病人,术前25mg赛尼哌可显著降低AR发生率,且安全性好。但对于移植肾功能延迟恢复病人,术前25mg赛尼哌并不能有效预防排斥发生。

Abstract: Objective To investigate the efficacy and safety of half-dose Zenapax for prevention of acute rejection after renal transplantation.Methods According to the immunosuppressive regimen and renal function after transplantation,patients were divided into 4 groups,namely groups A,B,C,and D of 90,73,11 and 13 patients,respectively.Blood creatinine measured 1 week after operation was <176.6 μmol/L in groups A and B,and was >353 μmol/L in groups C and D.Patients in groups A and C were given 25 mg Zenapax(0.5 mg/kg)and MMF 0.75 g before operation,and those in groups B and D had only MMF of 0.75 g.All patients were given Pred,CsA and MMF after operation,and the rejection episodes,the time of acute rejection onset,the rate of rejection reversal and complications were analyzed in the time period of 6 months after operation.Results After the operation,13 patients(14.4%)developed acute rejection in group A,18(24.6%)in group B,6(54.5%)in group C and 7(53.8%)in group D(P<0.01).The incidence of acute rejection in group B was significantly lower than that in groups C and D groups(P<0.01),and the latter two groups had similar incidence.The time of acute rejection onset ranged from 3 to 9 days postoperatively(mean 6.2±3.2 days)in group A,significantly delayed as compared with that in group B(range 2-8 days,mean 4.7±3.1days),group C(range 2-7 days,mean 4.3±4.2 days)and group D group(range 2-9 days,mean 3.9±3.5 days),but the time was similar between groups B,C,and D(P>0.05).All acute rejection cases in group A was reversed,and the rate of reversal was 88.9%(16/18)in group B,83.3% in group C,and 71.4% in group D.No significant differences were noted in such complications as infection,vascular injuries or gastrointestinal reactions between the 4 groups(P>0.05).Conclusion Zenapax at the dose of 25 mg can safely decrease the risk of acute rejection in patients with good postoperative renal function recovery,but dose not seem effective in patients with delayed graft function recovery.

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