肺移植围手术期以发热为主要表现的抗体介导排异反应  

Early-onset antibody-mediated rejection with fever as the main manifestation after bilateral lung transplantation:a case report

作　　者：崔晓阳[1] 王蓓[2] 詹庆元[1] 刘敏[3] 陈文慧[4] Cui Xiaoyang;Wang Bei;Zhan Qingyuan;Liu Min;Chen Wenhui(Department of Pulmonary and Critical Care Medicine,China-Japan Friendship Hospital,National Center for Respiratory Medicine,National Clinical Research Center for Respiratory Diseases,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,Beijing 100029,China;Department of Pathology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Radiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Lung Transplantation,China-Japan Friendship Hospital,National Center for Respiratory Medicine,National Clinical Research Center for Respiratory Diseases,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,Beijing 100029,China)

机构地区：[1]中日友好医院呼吸与危重症医学科国家呼吸医学中心、国家呼吸临床研究中心、中国医学科学院呼吸病学研究院,北京100029 [2]中日友好医院病理科,北京100029 [3]中日友好医院放射科,北京100029 [4]中日友好医院肺移植科国家呼吸医学中心、国家呼吸临床研究中心、中国医学科学院呼吸病学研究院,北京100029

出　　处：《中华结核和呼吸杂志》2024年第12期1135-1139,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：呼吸疾病青年实用研究项目(院校级Z-2017-24-2301)。

摘　　要：抗体介导排异反应(AMR)是肺移植术后排异反应的一种表现形式,是由于受者体内抗供者人类白细胞抗原(HLA)和(或)非HLA抗体导致的排异反应,根据是否存在移植物功能障碍表现分为临床型及亚临床型。本文报道1例双肺移植术后早期,以发热为主要表现的临床型AMR,经血浆置换及丙种球蛋白静点治疗后病情好转。Antibody-mediated rejection(AMR)is a recognized cause of allograft dysfunction in lung transplant recipients due to the presence of donor-specific anti-human leukocyte antigen(HLA)antibodies(DSAs).Here,we reported that a 69-year-old woman with underlying connective tissue disease-associated interstitial lung disease(CTD-ILD)developed recurrent fever with elevated white blood cells,C-reactive protein(CRP)and new ground-glass opacities on chest computed tomography(CT)early after double lung transplantation.After a thorough investigation for infection,rejection and relapse of primary immune diseases,the patient was found to be panel-reactive antibody(PRA)positive and DSAs positive.Pathology of the transbronchial lung biopsy(TBLB)revealed positive histology suggestive of AMR and positive C4d staining.The final diagnosis was definite clinical AMR.Following treatment with plasma exchange and intravenous immunoglobulin(IVIg)infusion,the patient′s condition improved significantly,and the patient was discharged from hospital.

关 键 词：肺移植 抗体特异性 移植物排斥 抗体 供体 

分 类 号：R655.3[医药卫生—外科学]