移植肾局灶性节段性肾小球硬化复发危险因素分析及治疗经验总结  

Risk factors and treatment of focal segmental glomerulosclerosis recurrence in renal transplantation

作　　者：王美芳[1] 崔瑜[1] 吕军好[1] 余献平[1] 黄洪锋[1] 王仁定[1] 陈江华[1] 吴建永[1] Wang Meifang Cui Yu Lyu Junhao Yu Xianping Huang Hongfeng Wang Rending Chen Jianghua Wu Jianyong(Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China)

机构地区：[1]浙江大学医学院附属第一医院肾脏病中心,杭州310003

出　　处：《中华移植杂志（电子版）》2017年第2期80-84,共5页Chinese Journal of Transplantation(Electronic Edition)

基　　金：浙江省重大科技专项基金(2012C13013-5)

摘　　要：目的探讨肾移植术后移植肾局灶性节段性肾小球硬化(FSGS)复发的危险因素及其治疗效果。方法回顾性分析2008年1月至2017年4月浙江大学医学院附属第一医院肾脏病中心16例原发病为FSGS的肾移植受者资料,根据术后移植肾FSGS早期复发情况分为复发组(6例)和未复发组(10例)。两组受者肾移植术前原发病发病年龄、肾移植手术时年龄和供者年龄比较采用t检验;两组受者肾移植术前进展至终末期肾病(ESRD)时间、HLA错配数和透析时间比较采用Mann-Whitney检验;两组受者性别、供肾方式、供者性别、是否进行免疫诱导和是否预防性使用利妥昔单抗比较采用Fisher确切概率法。P<0.05为差异有统计学意义。结果复发组和未复发组进展至ESRD的时间分别为1.0年(0.3~5.9年)和9.2年(0.5~14.0年),差异有统计学意义(U=7.00,P<0.05)。两组间受者性别、发病年龄、透析时间、供者类型、手术时年龄、HLA错配数、是否进行免疫诱导、是否预防性使用利妥昔单抗、供者年龄和性别等差异均无统计学意义(P均>0.05)。复发组6例受者经血浆置换联合大剂量环孢素治疗后,3例完全缓解,2例短期内部分缓解,1例部分缓解。结论早期使用血浆置换联合大剂量环孢素能快速、有效且持续缓解移植肾FSGS复发的病变程度和进程。原发性FSGS快速进展至ESRD时间可能是影响肾移植术后移植肾FSGS早期复发的重要因素。Objective To investigate the risk factors of focal segmental glomerulosclerosis（ FSGS） recurrence in renal transplantation and its therapy. Methods The clinical data of 16 patients with FSGS underwent transplantation between January 2008 to April 2017 in Kidney Disease Center,the First Affiliated Hospital,College of Medicine,Zhejiang University,were retrospectively analyzed. The rate of early recurrent FSGS after transplantation was observed in 16 patients. The effect of high-dose cyclosporine combined with plasma exchange was also observed. Including 6 cases in group with recurrence（ R group） and 10 cases in group without recurrence（ NR group）. The age at onset of primary disease,the patients＇ age and donors＇ age at transplantation were compared by t Test; the progressed to end stage renal disease（ ESRD） time,HLA mismatching numbers and duration of dialysis were compared by Mann-Whitney Test; the sex of recipients,donor type,the sex of donors,whether use the immunological induction and whether use the rituximab were compared by Fisher＇s Exact Test.P〈0. 05 was considered statistically significant. Results The progressed to ESRD time of R group and NR group was 1. 0 year（ 0. 3-5. 9 years） and 9. 2 years（ 0. 5-14. 0 years）,it＇ s statistically significant（ U = 7. 00,P〈0. 05）. The sex of recipients,the age at onset of disease,duration of dialysis,donor type,the age of the patients and the age of donors at transplantation,HLA mismatching numbers,whether use immunological induction,whether use the rituximabthe,age of donors and sex ofdonors,no differences were observed between two groups（ P all 0. 05）. Of the 6 patients in R group,3 achieved complete remission,2 achieved partial remission in a short term,1 achieved partial remission after the use of high-dose of cyclosporine combined with plasma exchange. Conclusions This study confirms that early using of high-dose of cyclosporine combined with plasma exchange can quickly,effectively and continuously relieve the degree and p

关 键 词：肾移植 局灶性节段性肾小球硬化 血浆置换 环孢素 利妥昔单抗 

分 类 号：R699.2[医药卫生—泌尿科学]