肝移植术后急性排斥反应的病理学特点及临床诊治分析  

Analysis of clinical diagnosis and treatment and pathological characteristics of acute rejection following orthotopic liver transplantation

作　　者：李军良[1] 马毅[1] 何晓顺[1] 王国栋[1] 胡安斌[1] 邰强[1] 朱晓峰[1] 胡瑞德[2] 

机构地区：[1]中山大学附属第一医院器官移植中心 [2]中山医学院病理学教研室,广东广州510080

出　　处：《第四军医大学学报》2009年第3期233-235,共3页Journal of the Fourth Military Medical University

基　　金：广东省科技计划项目(2008B030301296)

摘　　要：目的:探讨肝移植急性排斥反应的病理学特点、临床表现以及诊治经验.方法:回顾性分析2004-01/2006-12中山大学附属第一医院施行的516例原位肝移植患者的临床病理资料;对肝移植术后发生急性排斥反应患者的病理组织学改变、临床表现、诊治方案加以分析.结果:516例中,有86例患者发生106例次急性排斥反应,急排的发生率为16.7%(86/516);其中临界型改变9例次,轻度排斥反应(BanffⅠ级)36例次,中度(Ⅱ级)48例次,重度(Ⅲ级)13例次.106例次中,36例次急性排斥反应经调整药物后得到控制,65例次经用激素冲击治疗后得到控制;5例激素冲击治疗无效的患者中,3例患者接受OKT3治疗,2例最终行再次肝移植而治愈.结论:由于新一代免疫抑制剂的使用,肝移植急性排斥反应已缺乏典型的症状和体征,其病理改变可以有重叠和复合存在;移植肝穿刺活检仍是目前诊断的"金标准";根据不同急性排斥反应的临床病理特点,采用合理的个体化免疫抑制方案,对提高肝移植患者的长期存活率至关重要.AIM： To investigate the clinical diagnosis and treatment as well as pathological characteristics of acute rejection following orthotopic liver transplantation （OLT）. METHODS ： A retrospective analysis was conducted on pathohistological changes, clinical manifestations and treatment plans in 516 cases of acute rejection following OLT from January 2004 to December 2006 at the First Affiliated Hospital of Sun Yat-sen University. RESULTS： A total of 106 episodes of acute rejections happened in 86 cases of the 516 OLT recipients （ 16.7% ）. Of the 106 episodes, 9 were borderline, 36 mild （ Banff Ⅰ ） , 48 midrange （ Ⅱ ） and 13 severe rejection （ Ⅲ ）. Thirty-six of the 106 episodes were controlled by drug dosage adjustment, 65 were controlled by MP stoss therapy and 5 failed the MP stoss therapy, of whom 3 recipients received OKT3 and 2 underwent re-transplantation. CONCLUSION ： Acute rejection following OLT is short of typical signs and symptoms. Graft biopsy is still the ＂gold standard＂ to diagnose acute rejections. Designing individual-tailored immunosuppressive regime plays an important role in increasing the long-term surviving rate of OLT patients.

关 键 词：肝移植 急性排斥反应 肝穿刺活检 治疗 

分 类 号：R617[医药卫生—外科学]