肾移植术后早期排斥反应的处理  

The therapy in acute renal allograft rejection

作　　者：孙发林[1] 裴继云[1] 陈建中[1] 李景勤[1] 张金平[1] 

机构地区：[1]解放军第401医院肾病中心,山东青岛266071

出　　处：《临床泌尿外科杂志》2005年第4期196-198,共3页Journal of Clinical Urology

摘　　要：目的:探讨肾移植术后早期排斥反应(AR)的处理方法。方法:对14 例肾移植术后3 周内发生AR的患者,应用甲基泼尼松龙(MP)治疗7例,改硫唑嘌呤(Aza)为霉酚酸脂(MMF)治疗5例,抗CD3治疗6例。结果:应用MP治疗的7例中5例AR逆转,2 例无效;改Aza为MMF治疗的5 例3 例逆转,2 例无效(其中包括MP无效的2例改Aza为MMF治疗后1例逆转1例无效)。抗CD3 治疗6例4例逆转,2例无效(其中MP治疗无效改Aza为MMF治疗后仍无效的1例逆转,MP治疗无效的基础免疫为CsA加MMF加Pred 的1 例无效)。结论:MP可使大部分术后早期AR逆转。应用Aza的患者改用MMP后可使早期AR逆转,MP不能完全逆转的AR改用MMF后也有良好的效果。及时应用抗CD3几乎可使术后早期AR全部逆转。Objective:To discuss the diagnosis and therapy in inchoate acute renal allograft rejection(AR) after renal transplantation.Methods:14 cases were diagnosed as AR 3 weeks after renal transplatation according to the clinical symptoms, ultrasonic examination and nephritic function examination. 7 cases were treated with MP(Immunosuppression in 4 cases was CsA+Aza+Pred and that in 2 cases was CsA+MMF+Pred). 5 cases were treated with MMF instead of Aza(Immunosuppression was CsA+Aza+Pred),and 6 cases(Immunosuppression was CsA+MMF+Pred) were treated with anti-CD3. The curative effects of MP, MMF and anti-CD3 were appraised.Results:Among 7 cases of AR treated with MP, 5 cases were reversed after the treatment while 2 cases were not. 3 cases of AR treated with MMF instead of Aza were reversed and 2 cases were not. Among 2 cases that were not reversed after the treatment with MP, one case was reversed after the treatment with MMF instead of Aza while another was not. Among 6 cases treated with anti-CD3, 4 cases were reversed and the other were not. Among 2 cases that were treated with MP and MMF invalidly, one case was reversed after the treatment with anti-CD3.Conclusions:Most of the AR could be reversed after the application of MP. The AR could be reversed after changing Aza to MMF. MMF may have good effects on the AR that MP can not completely reverse. All cases of inchoate AR could nearly be reversed after application of anti-CD3. So anti-CD3 should be applied to serious AR cases in time.

关 键 词：肾移植 急性排斥反应 抗体 CD3 甲基泼尼松龙 骁悉 

分 类 号：R699.2[医药卫生—泌尿科学]