Meulders Q, Dallel T, Peraldi M N, Kanfer A, Sraer J D, Rondeau E
INSERM U 64, Service de Néphrologie A, Hôpital Tenon, Paris.
Presse Med. 1992 Dec 2;21(41):2024-6.
In order to prevent the adverse effects of a first OKT3 injection in renal transplant recipients, we administered polyclonal antilymphocyte globulins (ATG Fresenius, 4 mg/kg/j) for 3 days before OKT3 injection. Compared with a historical group of 5 patients who did not receive ATG pretreatment before OKT3 injection, the patients who were pretreated by ATG had a significantly lower absolute number of circulating lymphocytes before the first OKT3 injection (363 +/- 107 vs 1,230 +/- 80/mm3, P < 0.001), a lower raise in plasma TNF-alpha level 2 hours after OKT3 injection (178 +/- 42 vs 735 +/- 127 pg/ml, P < 0.005) and a significant decrease in frequency and intensity of clinical symptoms, mainly chills, dyspnea, and headaches. However, fever and peak creatinine level were similar in both groups. A 80 percent success rate of crisis treatment was achieved in both groups and there was no increase in infectious complications. In conclusion, pretreatment with ATG induces a lymphocyte depletion, and decreases the amounts of TNF-alpha released as well as the side-effects of a first OKT3 injection.
为预防肾移植受者首次注射OKT3的不良反应，我们在注射OKT3前3天给予多克隆抗淋巴细胞球蛋白（费森尤斯卡比公司生产的抗胸腺细胞球蛋白，4毫克/千克/天），共3天。与一个未在注射OKT3前接受抗胸腺细胞球蛋白预处理的5例患者的历史对照组相比，接受抗胸腺细胞球蛋白预处理的患者在首次注射OKT3前循环淋巴细胞的绝对数量显著更低（363±107对1230±80/立方毫米，P<0.001），在注射OKT3后2小时血浆肿瘤坏死因子-α水平的升高幅度更低（178±42对735±127皮克/毫升，P<0.005），并且临床症状的频率和强度显著降低，主要是寒战、呼吸困难和头痛。然而，两组的发热和肌酐峰值水平相似。两组的危机治疗成功率均达到80%，且感染并发症未增加。总之，抗胸腺细胞球蛋白预处理可导致淋巴细胞减少，并降低肿瘤坏死因子-α的释放量以及首次注射OKT3的副作用。
