You Position: Home > Paper
The clinical pathological characteristics and immunosuppresant conversion treatment of chronic allograft nephropathy
( views:362, downloads:116 )
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF ORGAN TRANSPLANTATION
- Issue:
- 7
- DOI:
- 10.3760/cma.j.issn.0254-1785.2007.07.010
- Key Word:
- 肾病;移植物;活组织检查,针吸;治疗结果;肾移植
Abstract： 目的 探讨慢性移植肾肾病(CAN)的病理学特点与临床应对策略.方法 对20例临床诊断为慢性移植肾功能减退、病理诊断为CAN者的病理资料进行系统分析,依据Banff97标准对肾小球硬化、间质纤维化、肾小管萎缩及小动脉内膜炎等CAN特征性表现进行综合评分后,做出病理诊断和分层分析.20例肾移植后采用以环孢素A(CsA)为基础的免疫抑制方案,诊断为CAN后,3例转换为他克莫司(FK506)与霉酚酸酯(MMF)联用,17例转换为西罗莫司(Sir)与MMF联用,比较转换治疗前后肾功能的变化.结果 9例(45%,9/20)合并发生亚临床排斥反应,激素冲击治疗有效;20例均存在间质纤维化、肾小管萎缩与肾小球硬化.慢性移植肾功能减退对转换治疗的反应与间质纤维化和肾小管萎缩的程度无明显相关性,但与肾小球硬化率密切相关,肾小球硬化率低于30%者预后良好,超过50%者移植肾功能丧失.结论 肾小球硬化率有可能成为判断CAN病变程度和预后的指标;治疗慢性移植肾功能减退时应重视合并发生的亚临床排斥反应,撤除CsA、采用Sir与MMF联用方案值得推荐.
- [1]董冲,陈知水,宫念樵,等.反义细胞外信号调节激酶对移植物血管的保护作用[J].2006,(2).
- [2]宫念樵,肖建生,叶启发,等.慢性移植物肾病组织补体C4d沉积的意义[J].2005,(7).
- [3]郑克立,王长希,陈立中,等.雷帕霉素联合环孢素和皮质类固醇预防肾移植急性排斥反应的临床研究[J].2004,(4).
- [4]宫念樵,杜敦峰,董冲,等.腺病毒介导的血红素氧合酶-1基因治疗对同种移植物慢性排斥反应损伤的保护作用[J].2007,(4).
- [5]Cornell LD,Colvin RB.Chronic allograft nephropathy.[J].2005,14(3).
- [6]Paul I, Terasaki.Humoral theory of transplantation.[J].2003,3(6).
- [7]T, Mukherjee,B V, Shah.Sirolimus: a new immunosuppressant.[J].2005,53.
- [8]Yang J,Reutzel Selke A,Steier C,etc.Targeting of Macrophage Activity by Adenovirus-Mediated Intragraft Overexpression of TNFRp55-Ig, IL-12p40, and vIL-10 Ameliorates Adenovirus-Mediated Chronic Graft Injury, whereas Stimulation of Macrophages by Overexpression of IFN-gamma Accelerates[J].2003,14(1).
- [9]Terasaki PI,Cai J.Humoral theory of transplantation: further evidence.[J].2005,17(5).
- [10]T F, Andoh,E A, Burdmann,W M, Bennett.Nephrotoxicity of immunosuppressive drugs: experimental and clinical observations.[J].1997,17(1).
- [11]Dudley C,Pohanka E,Riad H,etc.Mycophenolate mofetil substitution for cyclosporine a in renal transplant recipients with chronic progressive allograft dysfunction: the "creeping creatinine" study.[J].2005,79(4).
- [12]Claesson K,Johnson RW,Kreis H,etc.Sirolimus allows early cyclosporine withdrawal in renal transplantation resulting in improved renal function and lower blood pressure.[J].2001,72(5).
- [13]Solez K,Hill CM,Gibson IW,etc.The Banff 97 working classification of renal allograft pathology.[J].1999,55(2).
- [14]Borrows RJ,Fung CL,Nankivell BJ,etc.The natural history of chronic allograft nephropathy.[J].2003,349(24).