小剂量静脉滴注人免疫球蛋白在群体反应抗体阳性肾移植患者中的临床应用分析

A clinical analysis for low-dose immunoglobulin united with plasmapheresis in high sensitization renal transplantation recipients

摘要:

目的  探讨群体反应抗体（PRA）阳性肾移植受者应用小剂量人免疫球蛋白（IVIG）后，PRA的下降程度以及移植肾功能的恢复效果。方法  ①观察组：A组术前高PRA肾移植患者4例；B组术后出现移植肾功能延迟恢复，监测出PRA升高患者7例；C组术后远期出现血肌酐升高，监测PRA升高同时病理穿刺证实为体液性排斥反应患者8例；②对照组：回顾性、随机挑选既往与A、B、C组同样表现的患者。治疗方案：A、B组血浆置换（PP）联合小剂量IVIG持续静脉滴注0.1 g/（kg·d）；C组内固醇激素冲击联合小剂量IVIG持续静脉滴注0.1 g/（kg·d）；对照组治疗方案中无IVIG的应用。比较观察组与对照组PRA下降程度和患者的预后。结果  经系统性、阶段性治疗后，A、B、C组中PRA均有不同程度降低，与对照组比较，A组肾移植术后排斥反应发生几率、B组移植肾功能恢复时间、C组移植肾血肌酐下降程度高于对照组，差异有统计学意义。结论  与传统大剂量IVIG比较，小剂量IVIG也能有效降低肾移植受者PRA水平，其对高PRA水平患者的治疗具有积极意义，且大大降低医疗成本。

Abstract:

Objective To analyze the role of low-dose intravenous immunoglobulin (IVIG) united with plasmapheresis in high sensitization renal transplantation recipients. Methods Four patients with high levels of panel reactive antibodies (PRA) before transplantation (group A), 7 patients with delayed renal graft function with high PRA levels (group B) and 8 recipients with humoral rejection with high PRA levels (group C) were enrolled into observe group (19 cases); and other 17 patients with the same manifestations were included into control group. Low-dose IVIG united with plasmapheresis was used in the observe group, the aequales treatment without IVIG was used in the control group. The differences in PRA levels and patients' prognosis were analyzed between the observe group and the control group. Results The descent of PRA level showed a significant difference between the observe group and the control group. Compared to the control group, the rejection rate after transplantation increased in the group A, the recovery time of transplanted kidney function prolonged in the group B, serum creatinine decreased more obviously in the group C. Conclusions Low-dose IVIG united with plasmapheresis can decrease the PRA level in high sensitization renal transplantation recipients.