移植肾超急性排斥反应的病理学发生机制及临床对策探讨  

Appraisal of the pathogenetic mechanism and treatment in 64 cases of renal grafts with hyperacute rejection

作　　者：郑军华[1] 闵志廉[1] 朱有华[1] 李玉莉[1] 齐隽[1] 任吉忠[1] 王立明[1] 王亚伟[1] 徐丹凤[1] 周梅生[1] 董震[1] 

机构地区：[1]第二军医大学长征医院,上海200003

出　　处：《上海医学》1999年第9期522-525,共4页Shanghai Medical Journal

摘　　要：目的　进一步探讨移植肾超急性排斥（ Ｈ Ａ Ｒ） 的病理学发生机制及临床对策。方法　１９７８ 年６ 月至１９９８ 年２ 月共行同种异体肾移植１５２４／１６０４ 例次，６４ 例发生 Ｈ Ａ Ｒ，对其中６３ 例切除的移植肾标本分别从皮质、髓质及血管取材，行光镜和电镜观察。结果　早期肾间质小血管及肾小球毛细血管内大量红细胞淤滞为主要改变。随着排斥反应的进展，中性粒细胞在肾小球毛细血管腔内聚集，可见毛细血管腔内微血栓形成，并形成梗死灶。肾间质的改变主要为高度水肿，严重的伴间质出血。治疗结果：２１ 例术中即切除移植肾，４２ 例于术后第１ ～２０ 天切肾，仅１ 例移植肾逐渐萎缩未予摘除。首次肾移植失败原因为超急性排斥２６ 例，其中１５ 例经严格配型、血浆置换及 Ａ Ｔ Ｇ 治疗，在１～１７ 天内行再次移植，１０ 例成功。另外１１ 例在术后６ 个月～２ 年后再行二次移植，仅４ 例获得成功（３６ ．３６ ％ ） 。结论　红细胞参加了移植肾的超急性排斥反应。反复输血；多次妊娠；再次移植；服用过人参、西洋参、中药及各种营养剂是 Ｈ Ａ Ｒ 发生的影响因素。Objective The purpose of this study was to further consider the pathologenetic mechanism and the clinical treatment of hyperacute rejection. Methods From June 1978 to Fabruary 1998, 1524/1604 cases of renal transplantation were performed in our hospital. 64 cases developed hyperacute rejection. 63 cases of the renal graft were studied by light microscopy, histochemistry and immuno histochemistry.Results A large number of red blood cells stagnated in small blood vessels of renal interstitium and blood capillaries of glomeruli during the early stage of hyperacute rejection. As the rejection progressed, the neutrophils were aggregated in the capillary bed of glomeruli. 21 renal graft were removed during the transplant surgery. 42 renal grafts were resected 1 to 20 days later. One renal graft gradually atrophice which was not removed. 26 cases failed because of hyperacute rejection who received retransplantation. 15 cases were done 1 to 17 days later, among which 10 were successful. Another 11 cases were done 6 months to 2 years later after the first operation and 4 were successful. Conclusion It is anticipated that the stagnant red blood cells might take part in hyperacute rejection. Factors influencing hyperacute rejection are: repeated blood transfusions; multiple pregnancies; retransplantation; Oral intake of ginseng, American ginseng or other Chinese herbs and nourishment in the past.(Shanghai Med J, 1999,22∶522 525)

关 键 词：超急性排斥 肾移植 病理学 发生机制 

分 类 号：R699.2[医药卫生—泌尿科学] R392.4[医药卫生—外科学]