NEJM：HLA不相容移植后免疫排斥的治疗

2017-08-03 zhangfan MedSci原创

研究认为酿脓链球菌内切酶可以减弱供体特异性抗体的作用，用于HLA不相容移植后免疫排斥的治疗

供体特异性抗体是导致排异反应的主要原因，对于HLA高度不相容移植者，现有的排异反应治疗效果效果不佳。肽链内切酶--源于酿脓链球菌(IdeS)，可将人类IgG分解为F(ab')2和Fc片段，抑制补体和抗体依赖的细胞毒作用，具有潜在的缓解排异反应作用。近日研究人员开展了一项I-II期临床研究考察IdeS 用于HLA不相容供体肾移植后的脱敏治疗。研究招募了25名HLA敏感患者，在接受HLA不相容肾移植前进行了IdeS 治疗，对患者的不良事件、结果、供体特异性抗体和肾功能进行严密监控。移植后使用的免疫抑制剂包括他克莫司、霉酚酸酯、糖皮质激素。部分患者静脉注射免疫球蛋白和利妥昔单抗防止移植后排异反应。研究发现静脉注射免疫球蛋白和利妥昔单抗的患者，其冷缺血期显著延长、移植肾功能延迟恢复率较高以及I型供体特异性抗体水平较高。15名患者发生了38起严重不良事件，其中5起可能与IdeS相关。接受IdeS治疗后，IgG以及HLA抗体完全消除，24名患者进行了灌注移植，在移植后的2周至5个月内，10名患者进行了抗体介导排斥反应治疗，IdeS治疗的反应率为100%。研究认为酿脓链球菌内切酶可以减弱供体特异性抗

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2017-08-04 lvygwyt2781

#排斥#

78 0
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2017-08-04 marongnuan

#HLA#

79 0
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2017-08-04 ms6829001416292975

#免疫排斥#

78 0
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2017-08-04 1ddf0692m34(暂无匿称)

学习了，涨知识

98 0
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2017-08-03 139****5926

好好文章学习了

91 0
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2017-08-03 135****7952平儿

学了。。。。。。。。。。。。

73 0
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2017-08-03 明月清辉

谢谢分享，学习了

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