狼疮肾炎终末期肾病患者尸体肾移植疗效观察  

The effectiveness of cadaver kidney transplantation in lupus nephritis end stage renal disease

作　　者：吴培根[1] 申伟[1] 尹培达[1] 李广然[1] 王长希[2] 余学清[1] 

机构地区：[1]中山大学附属第一医院肾内科,广州510080 [2]中山大学附属第一医院移植科,广州510080

出　　处：《中华风湿病学杂志》2007年第9期541-543,共3页Chinese Journal of Rheumatology

摘　　要：目的：探讨系统性红斑狼疮肾炎终末期肾病（LN-ESRD）患者肾移植的时机、疗效及术后狼疮活动情况。方法：回顾性分析16例LN-ESRD患者,女性14例,男性2例。年龄20～47岁,平均34.4岁。术前、术后狼疮活动指数（SLEDAI）,移植时机,移植后免疫抑制剂使用,人/肾存活情况。结果：16例患者术后10d内肾功能恢复正常。术后6个月内发生急性排斥3例（18.8%）,用甲泼尼龙（MP）冲击治疗后逆转。术前高血压10例,术后3个月后高血压7例,1例术后4个月因高血压脑出血死亡,当时无狼疮活动（SLEDAI〈10分）。15例至今仍存活,存活时间3～156个月,平均80.3个月）,其中有4例出现慢性移植肾肾病（1例重返透析治疗,3例肾功能不全,氮质血症期）,1例移植肾新发肾炎（病理检查为局灶、节段性硬化）,伴肾功能不全,氮质血症期。10例肾功能正常,其中1例出现少量蛋白尿。术前SLEDAI〈10分15例,SLEDAI〉10分1例（12分）,术后6个月后均无狼疮活动（SLEDAI〈10分）。本组患者定期追踪复查SLEDAI〈10分。结论：肾移植是治疗LN-ESRD有效的方法。狼疮无活动时,肾移植后系统性红斑狼疮复发率低。Objective To study the appropriate operation time for kidney transplantation, the effectiveness and the lupus activity after transplantation in patients with lupus nephritis-end stage renal disease （LN-ESRD）. Methods The systemic lupus erythematosus disease activity index （SLEDAI） of pre-and posttransplantation, the appropriate time for kidriey transplantation, the patient/graft survival state and the use of immunosuppressant after transplantation were analyzed retrospectively in 16 patients （14 female, 2 male, 20- 47 years old, with the average age of 34.4 years old）. Results The renal function of all grafts recovered in 10 days after transplantation. Acute rejection occured in 3 patients （18.8%） in 6 months, but reversed after methylprednisolone （MP） pulse treatment. Ten cases had pre-transplant hypertension, 7 cases had hypertension 3 months later. One patient died from cerebral hemorrhage 4 months later with normal renal function and no active lupus （SLEDAI〈10 scores）. Fifteen cases were still alive, while the graft had lived for 3-156 months （mean 80.3 months）. Among them, 4 cases had chronic graft renal disease （ 1 patient returned to dialysis, the other 3 become renal insufficient）; 1 case presented new-onset nephritis （focal segmental sclerosis）, with renal insufficiency. Ten cases had normal renal function. One of them had trace proteinuria. Before transplantation, SLEDAI was 〈10 scores in 15 cases, 〉10 in 1 case （12 scores）; while all the SLEDAI was 〈10 in 6 months after transplantation. All cases were followed-up regularly and the SLEDAI was 〈10. Conclusion Kidney transplantation is an effective way to treat LN-ESRD. The recurrence rate of SLE is low after kidney transplantation.

关 键 词：红斑狼疮 系统性 狼疮肾炎 尸体 肾移植 

分 类 号：R686[医药卫生—骨科学]