抗体介导排斥反应的精准诊疗  

Precision diagnosis and treatment of antibody-mediated rejection

作　　者：蔡俊超 庆欣 张雷 朱兰 刘龙山[5] 田普训[6] 陈刚[4] Cai Junchao;Qing Xin;Zhang Lei;Zhu Lan;Liu Longshan;Tian Puxun;Chen Gang(Suzhou Caibo Medical Research Institute,Suzhou 215009,China;Department of Pathology,Harbor-UCLA Medical Center,USA 90501;Department of Organ Transplantation,Changhai Hospital,Naval Medical University,Shanghai 200433,China;Institute of Organ Transplantation,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China;Department of Organ Transplantation,First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of Kidney Transplantation,First Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]苏州才博医学研究所,苏州215009 [2]Harbor-UCLA医学中心病理科,美国90501 [3]海军军医大学附属长海医院器官移植科,上海200433 [4]华中科技大学同济医学院附属同济医院器官移植研究所,武汉430030 [5]中山大学附属第一医院器官移植科,广州510080 [6]西安交通大学第一附属医院肾移植科,西安710061

出　　处：《中华器官移植杂志》2024年第1期1-17,共17页Chinese Journal of Organ Transplantation

摘　　要：通过分析抗体介导的排斥反应(antibody-mediated rejection,AMR)的发生机制和急慢性组织损伤的病理学特征,提出4个AMR的对因和对症防治措施:①针对AMR的病因,清除抗体和抗体产生细胞;②针对抗体引起的原发性内皮损伤机制,阻断补体依赖的损伤机制和阻断抗体依赖细胞介导的损伤;③针对内皮损伤后继发性的微血管管腔内血栓形成,进行抗凝溶栓治疗;④针对内皮损伤后继发性的急慢性血管性炎症反应进行抗炎治疗。本文强调,"对因措施"在AMR的防治中是最为重要的,但抗凝、溶栓和抗炎等对症措施也不可被忽视。最后,本文根据这些防治措施各自不同的特点和适应证,针对非致敏和致敏患者AMR的预防、活动性AMR受者的治疗、慢性活动性AMR受者的治疗,分别提出相应的综合防治建议方案。Based upon the underlying mechanism and pathological evidence of tissue injury of antibody-mediated rejection(AMR),four etiological and symptomatic therapies were proposed for managing AMR,including etiological treatment of AMR including antibody-targeting,B cell or plasma cell-targeting therapies;strategies for preventing antibody-mediated endothelial damage:an inhibition of complement/antibody dependent cell-mediated pathways;anticoagulant&thrombolytic therapies for thrombotic microangiopathy secondary to endothelial damage;anti-inflammatory therapies for acute/chronic vascular inflammation secondary to endothelial damage.Etiological treatment is essential for preventing and treating AMR while symptomatic measures,such as anticoagulant,thrombolytic and antiinflammatory therapies,are stressed.Finally the authors devised therapeutic strategies for AMR in 4 different patient groups of non-sensitized allograft recipients,sensitized allograft recipients,individuals with active AMR and those with chronic active AMR.

关 键 词：供者特异性抗体 抗体介导的排斥反应 补体依赖的细胞毒 补体依赖的细胞介导的细胞毒 补体依赖的细胞介导的细胞吞噬 抗体依赖的细胞介导的细胞毒 抗体依赖的细胞介导的细胞吞噬 精准治疗 

分 类 号：R392[医药卫生—免疫学]