移植肾术后急性抗体介导性排斥反应的诊断与治疗  

Diagnosis and treatment of acute antibody-mediated rejection after renal transplantation

作　　者：韩永[1] 蔡明[1] 郭晖[2] 周文强[1] 肖漓[1] 王强[1] 许晓光[1] 黄海燕[1] 石炳毅[1] 

机构地区：[1]解放军第309医院全军器官移植研究所器官移植与免疫调节北京市重点实验室,北京100091 [2]华中科技大学同济医院器官移植研究所教育部/卫生部器官移植重点实验室,武汉430030

出　　处：《中华实用诊断与治疗杂志》2015年第1期34-36,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金面上项目(31371395)

摘　　要：目的观察肾功能不全移植肾术后3个月内急性抗体介导性排斥反应的诊断和治疗方法。方法肾移植术后患者106例,均在B超引导下行移植肾穿刺活检组织病理检查,观察移植肾病理改变情况;采用免疫组织化学染色观察移植肾C4d表达情况;确诊急性抗体介导性排斥反应后给予血浆置换和静脉注射小剂量丙种球蛋白等治疗,观察治疗效果。结果移植肾超急性排斥反应2例,急性抗体介导性排斥反应15例;免疫组织化学染色示C4d均为阳性;2例超急性排斥反应移植肾失功,移植肾切除;15例急性抗体介导性排斥反应患者中13例治疗后移植肾功能恢复,2例移植肾功能未恢复,血肌酐稳定于较高水平。结论移植肾穿刺活检组织病理对肾移植术后移植肾功能不全的诊断有重要意义,血浆置换及静脉注射小剂量丙种球蛋白在肾功能不全移植肾术后急性抗体介导性排斥反应治疗中有积极作用。Objective To explore the diagnosis and treatment of acute antibody-mediated rejection in perioperative 3 months after renal transplantation in patients with renal insufficiency.Methods The graft kidneys in 106 patients received ultrasound-guided biopsy after renal transplantation.The pathological changes were observed by the pathological method.C4 dexpression was detected by immunohistochemical staining.Acute antibody-mediated rejection was treated by plasmapheresis and intravenous immunoglobulin.The therapeutic effect was observed.Results Hyperacute rejection occurred in 2 patients and acute antibody-mediated rejection occurred in 15.C4 dimmunohistochemical staining was positive.After treatment,renal function failure occurred in 2 patients with hyperacute rejection,and resection of graft kidney was performed.In 15 patients with antibody-mediated rejection,renal function was recovered in 13 and creatinine remained a high level in the other 2 patients with unrecovered renal function.Conclusion Renal puncture biopsy has an important guiding significance in the diagnosis of renal insufficiency after renal transplantation.Plasmapheresis plus low dose intravenous immunoglobulin is effective for acute antibody-mediated rejection after renal transplantation for renal insufficiency.

关 键 词：肾移植 移植肾穿刺 组织病理 

分 类 号：R699.2[医药卫生—泌尿科学]