巴利昔单抗对肾移植受者白细胞介素2和可溶性白介素2受体的影响

目的:分析巴利昔单抗和抗CD3单克隆抗体(OKT3)对肾移植受者白细胞介素2(IL2)和可溶性白细胞介素2受体(sIL2R)的影响,评价其治疗的有效性及安全性。方法:将74例肾移植受者随机分为巴利昔单抗组(n=39)和OKT3组(n=35)。所有病人均采用环孢素+霉酚酸酯+泼尼松三联免疫抑制维持治疗。巴利昔单抗组:分别于术前2h和术后d4使用巴利昔单抗20mg,静脉滴注;OKT3组:从术后d1开始,给OKT35mg静脉滴注,qd,共7～10d。检测术后2mo内IL2和sIL2R浓度,观察急性排斥反应(AR)、肌酐恢复时间、不良反应、受者和移植肾存活情况。结果:巴利昔单抗组IL2和sIL2R浓度明显低于OKT3组(P<0.05)。有12例病人发生AR,巴利昔单抗组3例,OKT3组9例(P<0.05)。巴利昔单抗组肌酐恢复时间(4.7±s2.1)d,明显短于OKT3组(9±5)d(P<0.05)。巴利昔单抗组感染7例,细胞因子释放综合征0例,过敏反应0例,明显低于OKT3组(P<0.05)。结论:巴利昔单抗明显降低IL2和sIL2R浓度和AR发生率,不良反应少,是一种强效安全的免疫抑制剂。

Influence of basiliximab and on recipients' interleukin-2 and soluble interleukin-2 receptor after renal transplantation

AIM: To analyze the influence of basiliximb and anti-CD 3 monoclonal antibody (OKT3) on renal transplant recipients' interleukin-2(IL-2) and soluble interleukin-2 receptor (sIL-2R) by basiliximab and evaluate the efficacy and safety of basiliximab and OKT3. METHODS: Seventy-four recipients were divided into basiliximab group(n=39) and OKT3 group (n=35). All recipients were taken triple immunosuppressive therapy with steroids, mycophenolate mofetil and cyclosporine. Basiliximab group received basiliximab(20 mg) iv, drip 2 h before operation and d 4 postoperation. OKT3 group received OKT3 (5 mg·d -1) iv, drip from postoperative d 1 for 7 or 10 d. The concentrations of IL-2 and sIL-2R at different time points in 2 mo after transplantation were detected. Acute rejection, renal function, adverse reactions and survival rates of grafts and recipients within 2 mo after transplantation were observed. RESULTS: The concentration of IL-2 and sIL-2R in basiliximab group was significantly lower than that in OKT3 group(P< 0.05). During a follow-up 2 mo 3 patients were subjected to acute rejection(AR) in basiliximab group and 9 in OKT3 group(P< 0.05).The time of recovery of renal function in basiliximab group(4.7±s 2.1) d was earlier than that in OKT3 group (9±5) d (P< 0.05). The incidences of infection, cytokine release syndrome and allergic reaction in basiliximab group were significantly lower than those in OKT3 group(P< 0.05). CONCLUSION: Basiliximab is a safe and effective induction therapeutic agent and can significantly reduce the concentration of IL-2 and sIL-2R, occurrence rate of AR.