广泛致敏受者肾移植术前行血浆置换的效果研究  

Effect of Preoperative Plasma Exchange for Widely Sensitized Recipients with Renal Transplantation

作　　者：张靖华[1] 王长安[1] 梁亚林[1] 黑小杰[1] 

机构地区：[1]河南省郑州市第七人民医院肾移植肾内科,450000

出　　处：《中国全科医学》2014年第3期286-288,共3页Chinese General Practice

基　　金：郑州市科技攻关项目(121PPTGG497-4)

摘　　要：目的探讨广泛致敏受者肾移植术前行血浆置换的效果。方法选取郑州市第七人民医院2010年3月—2012年6月门诊及住院就诊的30例群体反应性抗体(PRA)较高准备行肾移植患者,根据治疗方法不同分为对照组和试验组各15例,对照组术前给予常规抗排斥反应治疗,试验组给予血浆置换。观察两组PRA水平、急性排斥反应发生率及病死率。结果治疗后对照组PRA水平(29.28±8.47)%,高于试验组的(21.68±6.25)%(t=6.231,P<0.05)。对照组急性排斥反应发生率为40%(6/15),高于试验组的7%(1/15)(χ2=11.528,P<0.05)。所有患者肾移植手术顺利,随访1年,对照组死亡4例,试验组死亡1例,两组病死率比较,差异有统计学意义(Uc=4.025,P<0.05)。结论血浆置换在致敏受者肾移植中起重要的辅助作用,能避免接受靶抗原阳性供肾,从而减少排斥反应,提高术后生存率。Objective To explore the effect of preoperative plasma exchange for widely sensitized recipients with renal transplantation. Methods 30 outpatients and inpatients who were with high Panel Reactive Antibody （ PRA ） and were about to undergo renal transplantation were selected in the Seventh People＇s Hospital of Zhengzhou City from March 2010 to June 2012. The patients were divided into control group and experiment group in accordance with treatment methods with each group 15 cases. The control group was given conventional anti - rejection therapy before operation, while the treatment group was given plasma exchange. The PRA level and incidence of acute rejection and mortality were observed between the two groups. Results After treatment, the PRA level in the control group was significantly higher than that in the experiment group [ （29.28 ± 8.47） % vs. （ 21.68 ± 6. 25 ） %, t = 6. 231, P 〈 0. 05 ] . The incidence of acute rejection in the control group was significantly higher than that of the experiment group [40% （6/15） vs. 7% （ 1/15 ）, χ2 = 11. 528, P 〈 0. 05 ] . All patients had successful renal transplantation and were followed up for one year. 4 patients in the control group and one in the experiment group died. The mortality between the two groups showed statistically significant difference （ Uc = 4. 025, P 〈 0. 05 ） . Conclusion Plasma exchange plays an important supporting role in sensitized renal transplantation to avoid accepting the target antigen positive donor kidney, thus reducing the rejection and increasing postoperative survival.

关 键 词：血浆置换 肾移植 HLA抗原 移植物排斥 

分 类 号：R617[医药卫生—外科学]