应用抗CD3单克隆抗体预防肾移植术后急性排斥反应的体会

目的 观察国产抗CD3单克隆抗体在预防肾移植术后急性排斥反应中的作用。方法 将60例患者随机分为3组，每组20例，3个组移植术后均给以环孢素A、硫唑嘌呤和皮质激素组成的三联免疫抑制方案；全量组加用抗CD3单克隆抗体5mg/d，半量组加用抗CD3单克隆抗体2.5mg/d，对照组不用。观察术后肾功能的恢复情况及急性排斥反应发生率。结果 术后1周使用抗CD3单克隆抗体者的血肌酐低于对照组（P＜0．05），10d后二者的差异无显著性；在术后头3个月，使用抗CD3单克隆抗体治疗组与对照组在急性排斥反应发生率方面的差异有显著性（P＜0．05）；使用抗CD单克隆抗体全量组与半量组在术后肾功能恢复及急性排斥反应发生率方面的差异无显著性。结论 术后早期预防性使用抗CD3单克隆抗体对移植肾功能的恢复和降低急性排斥反应发生率有较好的作用；给予半量的抗CD3单克隆抗体能取得与全量同样的效果，且费用较低，并发症少。

Clinical experience of using monoclonal antilymphocyte globulin OKT3 to prevent allograft rejection episodes after renal transplantation

Objective To observe the role of monoclonal antilymphocyte globulin OKT3 in preven ting allograft rejection episodes after renal transplantation.Method 60 patients were randomly divided three groups: guoup 1 ( n =20) receiving OKT3 5?mg/day; group 2 ( n =20) receiving OKT3 2.5 ?mg/day; group 3 ( n =20) served as control. Three groups were all given traditional three immunosuppressive treatment: CsA+Aza+Pred. The recovery of renal function and occurrence of rejection after opration were observed.Results After operation, Scr in the group 1 and group 2 was lower than in the control group one week after renal transplantation ( P < 0.05 ), but no significant difference was found 10 days after operation. At the first three months after operation,there was significant difference in the acute rejection episodes between experimental groups and control group. There was no significant difference in the recovery of renal function and the acute rejection episodes between group 1 and group 2.Conclusion Early prophylactic use of OKT3 may play important roles in the recovery of renal function and decreasing incidence rate of acute rejection after operation. Use of 2.5 ?mg/d OKT3 had the same results as 5?mg/d OKT3.