中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (18): 3333-3336.doi: 10.3969/j.issn.1673-8225.2011.18.025

• 移植与免疫 transplantation and Immunology • 上一篇    下一篇

肾移植后急性体液性排斥反应的治疗

沈蓓莉，李玉华，胡俊杰，王素静，胡盟培，李晓燕   

  1. 郑州人民医院肾器官移植科，河南省郑州市450003
  • 收稿日期:2010-10-08 修回日期:2010-12-16 出版日期:2011-04-30 发布日期:2011-04-30
  • 作者简介:沈蓓莉，女，1972年生，河南省郑州市人，汉族，1997年新乡医学院毕业，副主任医师，主要从事肾内科临床方面的研究。 15903711568@139.com

Treatments for acute humoral rejection after renal transplantation

Shen Bei-li, Li Yu-hua, Hu Jun-jie, Wang Su-jing, Hu Meng-pei, Li Xiao-yan   

  1. Department of Renal Transplantation, Zhengzhou People’s Hospital, Zhengzhou   450003, Henan Province, China
  • Received:2010-10-08 Revised:2010-12-16 Online:2011-04-30 Published:2011-04-30
  • About author:Shen Bei-li, Associate chief physician, Department of Renal Transplantation, Zhengzhou People’s Hospital, Zhengzhou 450003, Henan Province, China 15903711568@139.com

PDF

307

摘要：

背景：肾移植后急性体液性排斥反应是一类人类白细胞抗原抗体介导的排斥反应，常导致移植物丧失功能。目前，强效免疫抑制剂和B淋巴细胞抑制剂的应用使急性体液性排斥反应的逆转率明显提高。
目的：探讨肾移植后急性体液性排斥反应的治疗方案。
方法：对20例发生急性体液性排斥反应的肾移植受者进行回顾性分析，患者给予抗胸腺球蛋白、蛋白A免疫吸附和大剂量丙种球蛋白联合治疗，所有患者均在蛋白A免疫吸附初次治疗前和末次治疗后留血标本测定群体反应性抗体和血清免疫球蛋白IgG，IgA，IgM。
结果与结论：20例患者急性体液性排斥反应均有效逆转。随访48个月，1例患者在移植后5个月时因合并严重的肺部感染而停用免疫抑制剂，继而发生剧烈的急性排斥反应而行移植肾切除，恢复血液透析，其余患者移植肾功能良好，至随访终点时平均血肌酐浓度为(132.6±44.2)µmol/L。提示，抗胸细胞球蛋白联合蛋白A免疫吸附和大剂量丙种球蛋白能够有效逆转肾移植后急性体液性排斥反应，成功率高，并发症少，且完全逆转的急性体液性排斥反应并不影响移植肾的预后。

关键词: 肾移植, 体液性排斥反应, 蛋白A免疫吸附, 血液透析, 随访

Abstract:

BACKGROUND: The acute humoral rejection after renal transplantation is a kind of human leukocyte antigen antibody-mediated rejection, which often leads to the loss of graft’s function. At present the application of potent immunosuppressive agents and B lymphocyte inhibitors significantly improve reversal rate of acute humoral rejection.
OBJECTIVE: To explore the therapeutic regimen of acute humoral rejection after renal transplantation.
METHODS: A total of 20 cases with acute humoral rejection in renal transplant recipients were retrospectively analyzed, patients were treated with antithymocyte globulin, protein A immunoadsorption and large dose gamma globulin therapeutic alliance. All patients were first received protein A immunoadsorption treatment before and after the last treatment, blood preparation was used to detect panel reaction antibody and serum immune globulin IgG, IgA, IgM.
RESULTS AND CONCLUSION: Twenty cases with acute humoral rejection were effectively reverse. After 48 months follow-up, 1case stopped using immunodepressant due to severe pulmonary infection at 5 months after renal transplantation. And then gravis acute rejection was occurred, patients underwent removal of transplanted renal, hemodialysis was recovered. The graft function of the remaining patients is good, the average serum creatinine concentration was (132.6±44.2) µmol/L to the end point of follow-up. It is indicated that antithymocyte globulin combined with protein A immunoadsorption and large dose gamma globulin can effectively reverse acute humoral rejection after renal transplantation with high success rate, few complication, and completely reversed acute humoral rejection does not affect the prognosis of graft.

中图分类号: