肾移植术后早期与晚期单纯血管内膜炎对预后的影响  

Effect of early and late endarteritis upon clinical prognosis after renal transplantation

作　　者：林川 王波 林锦雯 王慧萍 周芹 黄洪锋 彭文翰 吴建永 王仁定 陈江华 Lin Chuan;Wang Bo;Lin Jinwen;Wang Huiping;Zhou Qin;Huang Hongfeng;Peng Wenhan;Wu Jianyong;Wang Rending;Chen Jianghua(Kidney Disease Center,First Affiliated Hospital,College of Medicine,Zhejiang University,Institute of Nephrology,Zhejiang University,Key Laboratory of Kidney Disease Prevention&Control Technology,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,浙江大学肾脏病研究所,浙江省肾脏病防治技术研究重点实验室,310003

出　　处：《中华器官移植杂志》2020年第4期252-256,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(81770752、81370851、81400716)。

摘　　要：目的:探讨肾移植术后早期(术后2周内)与晚期(术后2周后)发生的单纯血管内膜炎的临床预后。方法:选取2001年9月至2014年12月浙江大学附属第一医院肾脏病中心行肾移植后出现血肌酐升高并行移植肾穿刺活检的受者,分析比较43例早期血管内膜炎组与38例晚期血管内膜炎组在基线情况、血肌酐、肾小球滤过率(GFR)、是否采用激素联合抗体治疗、抗排斥反应逆转率、移植肾功能丧失率以及移植肾存活率等指标的差异。结果:早期单纯血管内膜炎组排斥前及排斥时肌酐、GFR值均明显差于晚期单纯血管内膜炎组;早期单纯血管内膜炎组有37例(86.0%)采用激素联合抗体的治疗,晚期单纯血管内膜炎组仅有7例(18.4%),差异有统计学意义(P<0.001)。截至随访点早期单纯血管内膜炎组有10例(23.3%)发生移植肾功能丧失,晚期单纯内膜炎组有4例(10.5%),差异无统计学意义(P=0.131)。移植肾生存曲线提示两组肾存活时间差异无统计学意义。结论:肾移植术后早期单纯血管内膜炎受者病情明显重于晚期单纯血管内膜炎受者,但经过积极治疗以后,其预后不劣于晚期单纯血管内膜炎受者。Objective To explore the clinical prognosis of early endarteritis(within 2 weeks)and late endarteritis(after 2 weeks)after renal transplantation.Methods A total of 81 cases with higher creatinineand receiving renal biopsy after renal transplantation were recruited from September 2001 to December 2014.They were divided into early endarteritis group(n=43)and late endarteritis group(n=38).Baseline profiles,serum creatine,glomerular filtration rate(GFR)before and after treatment,steroid resistance,reversal rate,graft loss and survival rate were analyzed for two groups.Results Early endarteritis group showed worse serum creatine and GFR than late endarteritis group before rejection.Early endarteritis group had a higher rate of treatment with steroid plus antibody(86%)than that of late endarteritis group(86%vs.18.6%,P<0.05).No significant inter-group difference existed in graft loss(23.3%vs.10.5%,P=0.131).The survival curve of transplanted kidney showed no significant inter-group difference insurvival time.Conclusions The status of patients with early simple endothelitis is significantly worse than that of those with late simple endothelitis.However,after active treatments,the prognosis of patients with early simple endothelitis is not inferior to that of those with late simple endothelitis.

关 键 词：肾移植 血管内膜炎 预后 

分 类 号：R699.2[医药卫生—泌尿科学]