摘要
目的观察移植肾临界改变的转归及对肾功能的影响,探讨合适的治疗方案。方法2001年1月至2004年3月移植肾穿刺提示临界改变的受者110例,年龄14～65岁,平均39岁。其中44例为程序活检提示临界改变者(A组),未予抗排斥治疗;66例为术后6个月内肾功能异常行诊断性穿刺提示临界改变者(B组)行抗排斥治疗。另取102例程序活检提示移植肾状态者为对照组(C组)。比较随访期内的急性排斥发生率和术后6个月肾功能,并用免疫组化法观察间质炎性细胞的浸润情况。结果A、C组术后6个月内急性排斥发生率分别为6.8%(3/44)和4.9%(5/102)(P>0.05)。B组接受抗排斥治疗后,62例(93.9%)患者肾功能完全逆转。术后6个月,A、B、C组平均血肌酐水平分别为(109.00±20.75)、(122.67±27.28)、(109.23±18.28)μmol/L,B组与A、C组比较差异均有统计学意义,P值分别为0.009,0.003。B组间质浸润的CD8、CD68阳性细胞显著多于A组(P值分别为0.041,0.022)。结论对于病理表现为临界改变的肾移植受者,应密切结合临床,对于肾功能稳定者可不予抗排斥治疗,肾功能异常者应积极抗排斥治疗,CD8、CD68免疫组化染色有助于指导治疗。
Objective To observe the outcome of borderline changes defined in Banff schema of renal transplant recipients and its impact on allograft renal function, and to find out an optimal therapy. Methods From January 2001 to March 2004,110 renal transplant recipients （mean age, 39 years;age range, 14-65 years） with borderline changes were included. Of them ,44 recipients （group A） who had borderline changes in protocol biopsies had no anti-rejection treatment; and 66 recipients （group B） who had borderline changes in diagnostic biopsies underwent anti-rejection treatment. In addition, 102 recipients （ group C） with renal transplant status in protocol biopsies served as controls. The incidence of acute rejection and allograft renal function at 6 months following transplantation were compared between the 3 groups. And infiltration of inflammatory cells was semi-quantitatively evaluated by immunohistochemistry staining. Results Six months after transplantation, the incidence rates of acute rejection in groups A and C were 6.8% （3/44） and 4.9% （5/102） ,respectively （P 〉 0.05 ）. In 62 recipients （93.9%）of group B, the abnormal renal function was completely reversed after anti-rejection treatment. The serum creatinine level in group B [ （ 122.67 ± 27.28） μmol/L] was significantly higher than those in group A [ （ 109.00 ± 20.75 ） μmol/L] and group C [ （ 109.23 ± 18.28） μmol/L ] （ P = 0. 009 and P = 0. 003, respectively）. The numbers of CD8 and CD68 positive cells in group B were significantly higher than those in group A （ P = 0. 041 and P = 0. 022, respectively）. Conclusions In renal transplant recipients with borderline pathologic changes, management should be closely associated with the clinical manifestations. Anti-rejection therapy can be timely given in patients with renal dysfunction, while in patients with normal function, maintenance without additional treatment is recommended. CD8 and CD68 immunohistochemistry staining is useful in guiding the therapy.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第11期736-738,共3页
Chinese Journal of Urology
