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目的:评估应用二重血浆置换(DFPP)、免疫吸附(IA)联合IL-2受体单抗方案处理致敏肾移植受者的临床效果。方法:将56例致敏肾移植受者分为2组,35例试验组应用DFPP、IA联合IL-2受体单抗方案,21例对照组未进行上述处理。采用酶联免疫吸附(ELISA)方法检测肾移植受者体内群体反应性抗体(PRA)水平,比较2组急性排斥反应(AR)和肾功能延迟恢复(DGF)的发生率,随访2组人/肾1a存活率及术后6个月和12个月的血肌酐情况。结果:试验组PRA明显下降,PRA降为阴性者14例;试验组与对照组术后AR发生率分别为28.6%、42.9%(P<0.05),DGF发生率分别为8.6%、14.3%(P>0.05),1a人存活率分别为100.0%、95.2%(P>0.05),移植肾1a存活率分别为94.3%、76.2%(P<0.05),随访6个月/12个月血肌酐分别为(115.2±16.6)/(121.2±28.6)μmol.L-1和(128.4±27.4)/(134.6±33.7)μmol.L-1(P<0.05)。结论:DFPP、IA联合IL-2受体单抗方案可选择性去除受者体内的致敏抗体,可降低致敏受者术后AR的发生率,提高术后肾移植受者1a移植肾存活率,术后6个月和12个月的血肌酐水平也较低。
Objective: To evaluate the clinical effect of dual plasmapheresis (DFPP) and immunosorbent (IA) combined with IL-2 receptor monoclonal antibody in the treatment of sensitized kidney transplant recipients. Methods: 56 cases of sensitized kidney transplant recipients were divided into two groups. 35 cases of experimental group were treated with DFPP and IA combined with IL-2 receptor monoclonal antibody, and 21 cases of control group were not treated. The levels of PRA in renal transplant recipients were detected by enzyme-linked immunosorbent assay (ELISA). The incidences of acute rejection (AR) and delayed renal function recovery (DGF) were compared between the two groups. Survival of renal la and postoperative 6 months and 12 months of serum creatinine. Results: The incidences of postoperative AR were 28.6%, 42.9% (P <0.05), and the incidences of DGF were 8.6% and 14.3% in the experimental group Survival rate of transplanted kidney la was 94.3% and 76.2% respectively (P <0.05), followed by 6 months and 12 months of follow-up of serum creatinine (115.2 ± 16.6) / (121.2 ± 28.6) μmol.L-1 and (128.4 ± 27.4) / (134.6 ± 33.7) μmol.L-1, respectively, P <0.05). Conclusion: The combination of DFPP and IA combined with IL-2 receptor monoclonal antibody can selectively remove the sensitized antibodies in recipients, reduce the incidence of postoperative AR in sensitized recipients and increase the survival of recipients after transplantation Rate, 6 months after surgery and 12 months of serum creatinine levels are also lower.