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背景:目前生物制剂参与的免疫诱导治疗逐渐成为肾移植免疫抑制治疗方案的重要组成部分,既能有效预防急性排斥反应的发生,又能避免并发症的发生。目的:探讨不同生物制剂在肾移植免疫诱导治疗中对机体免疫状态及移植肾功能状态的影响。方法:回顾分析110例肾移植受者临床资料,根据应用生物免疫诱导治疗情况分组,单克隆抗体组(n=35)肾移植受者接受巴昔利单克隆抗体治疗,多克隆抗体组(n=43)肾移植受者接受兔抗人胸腺细胞免疫球蛋白治疗,对照组(n=32)肾移植受者未接受生物制剂免疫诱导治疗。对比分析3组受者在肾移植后1,4,12周的淋巴细胞绝对值、外周血CD4+T淋巴细胞亚群数量,并评价移植后12周内移植肾功能状态和感染并发症发生情况。结果与结论:单克隆抗体组、多克隆抗体组急性排斥反应发生率低于对照组(P<0.05),多克隆抗体组感染并发症发生率高于单克隆抗体组、对照组(P<0.05)。单克隆抗体组、多克隆抗体组移植后1,4,12周淋巴细胞绝对值均低于对照组(P<0.05)。多克隆抗体组移植后1,4,12周外周血CD4+T淋巴细胞亚群数量低于单克隆抗体组、对照组(P<0.05)。表明生物制剂参与的肾移植免疫诱导治疗方案可有效抑制移植受者活化T淋巴细胞功能状态,降低移植肾早期急性排斥反应的发生,但应用兔抗人胸腺细胞免疫球蛋白的感染并发症发生率较高。
BACKGROUND: At present, the immunotherapy induced by biological agents gradually becomes an important part of immunosuppressive therapy for renal allografts. It not only can effectively prevent the occurrence of acute rejection but also can avoid the occurrence of complications. OBJECTIVE: To investigate the effects of different biological agents on immune status and functional status of renal grafts during renal transplantation-induced immune therapy. Methods: The clinical data of 110 renal transplant recipients were retrospectively analyzed. According to the application of bio-immune therapy, the recipients of monoclonal antibody group (n = 35) received the monoclonal antibody to bevacizumab. Polyclonal antibody group (n = 43) Renal transplant recipients were treated with anti-human thymocyte immunoglobulin, while those in the control group (n = 32) were not immunized with biologic agents. The absolute value of lymphocytes, the number of CD4 + T lymphocyte subsets in peripheral blood at 1, 4, 12 weeks after kidney transplantation were compared among three groups of recipients, and the functional status of renal graft and the complication of infection within 12 weeks after transplantation were evaluated . RESULTS AND CONCLUSION: The incidence of acute rejection in the monoclonal antibody group and polyclonal antibody group was lower than that in the control group (P <0.05). The incidence of infection in the polyclonal antibody group was higher than that in the monoclonal antibody group and the control group (P <0.05) ). The absolute values of lymphocytes at 1, 4 and 12 weeks after transplantation in the monoclonal antibody group and the polyclonal antibody group were lower than those in the control group (P <0.05). The number of CD4 + T lymphocyte subsets in peripheral blood of polyclonal antibody group was lower than that of monoclonal antibody group and control group at 1, 4, 12 weeks after transplantation (P <0.05). The results showed that the biological treatment of kidney transplantation induced by immunotherapy could effectively inhibit the functional status of activated T lymphocytes in transplant recipients and reduce the incidence of acute rejection in early allograft recipients. However, the incidence of infection of rabbit anti-human thymocyte immunoglobulin Higher.