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角膜移植排斥反应多年来一直是困扰角膜移植患者复明的首要问题,目前许多新型的免疫抑制剂已逐渐应用于临床,有望成为治疗角膜移植排斥反应的有效药物。本文主要对角膜移植术后免疫排斥反应的临床类型,发生的机制以及治疗移植排斥反应药物的应用进展进行综述。 相似文献
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穿透角膜移植术后免疫排斥反应高危因素分析 总被引:11,自引:1,他引:10
为确立角膜移植术后免疫排斥反应的有效防治策略。对穿透角膜移植术后发生免疫排斥反应的86个病例(100只眼)进行回顾性总结。统计分析结果表明:血管化角膜、大植片移植、植床术前的活动性炎症,偏中心移植、多次移植、联合手术均应视为穿透角膜移植术后免疫排斥反应的高危因素,而移植片上皮反复脱落、旧病复发、术眼再次手术、缝线松解与拆线等可能是诱导排斥反应发生的促发因素。结论:从分子水平减少供受体间的抗原差异,研制新一代高效安全的免疫抑制剂、创造免疫耐度的理想环境可能是控制高危角膜移植免疫排斥反应的有效防治措施。 相似文献
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角膜移植术后免疫排斥反应是角膜移植失败的主要原因。免疫耐受是指抗原特异性的免疫无应答。诱导受体产生针对移植物的免疫耐受是彻底克服移植排斥反应的根本方法。角膜移植排斥反应是一个复杂且有多因素参与的过程。多种免疫细胞在抑制角膜移植术后排斥反应、诱导免疫耐受中,发挥着关键作用。因此,我们就近几年通过细胞诱导角膜移植免疫耐受的机制作一综述。 相似文献
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角膜移植免疫学研究进展 总被引:5,自引:0,他引:5
吕岚 《国外医学:眼科学分册》1996,20(3):136-140
移植排斥反应是角膜移植失败的首要原因。揭示其中的机理是预防和治疗免疫排斥反应的基础。本文综合了关于角膜移植免疫免性和免疫排斥方面的研究进展。 相似文献
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角膜盲人在我国约有200~300万,已经成为第二大致盲原因,角膜移植是这部分患者复明的唯一手段。角膜移植术是目前器官和组织移植成功率最高的手术,但术后的免疫排斥反应仍是手术失败的最主要原因。我国目前每年开展约5000例角膜移植手术。大样本量、前瞻性的研究显示,角膜移植后10年排斥反应发生1次的累积发生率为20%,而严重感染、化学伤等高危角膜移植患者,术后的免疫排斥反应发生率高达60%~90%,因此减少因免疫排斥反应导致的再次致盲是摆在我国广大从事角膜移植的眼科工作者亟待解决的问题。深刻地理解角膜移植排斥反应的发生机制,采取有效的预防措施,一旦发生免疫排斥反应则给予规范的免疫排斥治疗并加强随诊,对我国的防盲治盲工作具有重大的意义。 相似文献
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高危角膜移植术后免疫排斥反应规律的临床研究 总被引:8,自引:0,他引:8
目的 探讨不同病因的高危移植患者行穿透性角膜移植术后免疫排斥反应发生的规律。方法 对680例行穿透性角膜移植术中的124例134只眼高危移植患者术后排斥反应时间、排斥反应发生率及反应类型进行观察。结果 134只眼高危角膜移植术后免疫排斥反应发生率在12%~75%不等,其中角膜植床严重新生血管化者的排斥率最高。排斥发生时间最早为术后13天,术后3~6个月为排斥反应发生高峰。排斥反应类型以内皮型和上皮型最多。结论 不同高危因素的穿透性角膜移植术后排斥反应发生率不同,排斥反应发生的时间和类型也不同。 相似文献
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角膜移植免疫学研究进展 总被引:3,自引:0,他引:3
移植排斥反应是角膜移植失败的首要原因,揭示其中的机理是预防和治疗免疫排斥反应的基础。本文综述了关于角膜移植免疫赦免性和免疫排斥方面的究研进展。 相似文献
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角膜移植术后免疫排斥反应的防治进展 总被引:2,自引:0,他引:2
由于角膜的免疫赦免地位 ,角膜移植是众多器官和组织移植中成功率最高的 ,也是角膜盲患者复明的唯一手段。然而移植后的免疫排斥反应仍然是造成角膜移植术后失败的主要原因。尤其二次移植、新生血管化植床等高危因素的患者 ,术后的免疫排斥发生率高达 6 0~ 90 %。而目前我国多数为高危因素的患者。因此 ,有效的控制角膜移植术后免疫排斥反应的发生就成为角膜植片能否长期存活的关键所在。目前用于减少或防治角膜移植术后免疫排斥反应的方法综合如下 :1 组织配型组织配型主要包括主要组织相容性抗原 (HLA)配型和ABO血型抗原配型。在心脏… 相似文献
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角膜移植术后免疫排斥反应的探讨 总被引:1,自引:1,他引:0
目的:为有效控制角膜移植术后免疫排斥反应的发生,探讨角膜移植术后免疫排斥反应发生的因素。方法:对角膜手术后发生排斥反应者进行分析,总结发生的原因、时间,程度等,结果:123眼中发生免疫排斥反应46眼(37.4%),其中17眼发生不可逆的排斥反应,占排斥反应的36.96%;有角膜新生血管发生排斥反应41眼,占89.13%,内皮型排斥反应20眼,上皮型12眼,基质型3眼,混合型11眼,排斥反应发生时间为术后3周-3年,术后3-6月发生率最高,占46.48%,结论:免疫排斥反应的发生是多因素参与的复杂过程,与角膜新生血管的数量,角膜受损及感染的程度,植片的大小,手术的次数以及手术的时机和方式密切相关。 相似文献
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目的:为控制角膜移植术后发生排斥反应,探讨防治排斥反应的有效途径。方法:对73例73眼穿透性角膜移植术患者术后排斥反应发生率进行回顾性分析。结果:患者73眼中28眼发生免疫排斥反应(38%),其中高危角膜病变21眼,非高危角膜病变7眼,有角膜新生血管者占88%,排斥反应发生时间为术后2wk~3a,以内皮型排斥反应为主(43%)。经药物联合治疗,角膜排斥反应得到明显抑制,有效率达61%。结论:高危角膜病变免疫排斥反应几率明显增加,发生时间及持续时间较长,因此应根据不同角膜病变在术前、术中、术后采取相应措施减少排斥反应发生率。 相似文献
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目的 对穿透性角膜移植术后植片混浊的原因及二次穿透性角膜移植术的临床技巧及疗效进行初步研究.方法 回顾性研究,对40例因植片混浊行二次穿透性角膜移植术的患者,对原发病、植片混浊原因和两次手术时间二次移植的植片的大小进行分析,随访观察植片透明度、视力及免疫排斥情况.结果 感染性角膜炎居原发病首位.免疫排斥反应为植片混浊的主要原因,其次为植片感染性角膜炎复发、再发或继发.10例因植片感染于6个月及以内更换植片,30例因植片混浊于6个月以上更换植片.5例原直径过大而采用小直径植片;29例原直径≤8.25mm而采用等直径植片;6例因复发感染累及植片周边而扩大植片直径.随访32例植片(≤8.25mm)透明,视力较术前明显提高.8例植片混浊,其中5例混浊由免疫排斥所致.结论 造成二次穿透性角膜移植术的主要原因为植片免疫排斥和感染性角膜炎复发、再发或继发,据植片混浊不同病因采取不同直径的二次植片可有效减低免疫排斥反应发生率及治疗原发病复发或再发,延长植片透明时间. 相似文献
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Organ transplantation including cornea is often only the one method of treatment in case of their irreversible destruction. The genetic difference between donor and graft recipient makes the immunological system recognizes foreign antigens and triggers off a rejection episode. This article reviews corneal graft rejection immunology and indicates possible future options for the clinical evaluation of more specific therapeutic agents that modulate the immunological mechanisms of allograft rejection. It discusses also the role of HLA matching in the survival of corneal grafts especially in "high risk" eyes. 相似文献
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The greater success of corneal transplantation compared to other organ transplants has led to the concept that the cornea is a site of "immunological privilege." Corneal cells possess the antigens of the major histocompatibility complex responsible for allograft rejection in other tissues (i.e., HLA antigens). The avascularity of the cornea accounts for the relative protection of the donor cornea from the immunological surveillance of the recipient. As the roles and functions of the major histocompatibility complex are unravelled, the mechanisms responsible for host sensitization, lymphocyte activation and allograft rejection are becoming better understood. In particular, the HLA-DR antigen in humans is believed to play an integral part in allograft rejection. Langerhans cells in human corneal epithelium have been shown to bear this antigen. Evidence suggests that these cells or similar HLA-DR-bearing cells in the cornea play a major role in corneal allograft rejection. In light of these advances in transplantation immunobiology, new methods of suppressing and possibly preventing allograft rejection in corneal transplantation are presented. 相似文献
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Corneal graft rejection 总被引:3,自引:0,他引:3
Penetrating keratoplasty is the most widely practiced type of transplantation in humans. Irreversible immune rejection of the transplanted cornea is the major cause of human allograft failure in the intermediate and late postoperative period. This immunological process causes reversible or irreversible damage to the grafted cornea in several cases despite the use of intensive immunosuppressive therapy. Corneal graft rejection comprises a sequence of complex immune responses that involves the recognition of the foreign histocompatibility antigens of the corneal graft by the host's immune system, leading to the initiation of the immune response cascade. An efferent immune response is mounted by the host immune system against these foreign antigens culminating in rejection and graft decompensation in irreversible cases. A variety of donor- and host-related risk factors contribute to the corneal rejection episode. Epithelial rejection, chronic stromal rejection, hyperacute rejection, and endothelial rejection constitute the several different types of corneal graft rejection that might occur in isolation or in conjunction. Corneal graft failure subsequent to graft rejection remains an important cause of blindness and hence the need for developing new strategies for suppressing graft rejection is colossal. New systemic pharmacological interventions recommended in corneal transplantation need further evaluation and detailed guidelines. Two factors, prevention and management, are of significant importance among all aspects of immunological graft rejection. Preventive aspects begin with the recipient selection, spread through donor antigenic activity, and end with meticulous surgery. Prevention of corneal graft rejection lies with reduction of the donor antigenic tissue load, minimizing host and donor incompatibility by tissue matching and suppressing the host immune response. Management of corneal graft rejection consists of early detection and aggressive therapy with corticosteroids. Corticosteroid therapy, both topical and systemic, is the mainstay of management. Addition of immunosuppressive to the treatment regimen helps in quick and long term recovery. Knowledge of the immunopathogenesis of graft rejection may allow a better understanding of the immunological process thus helping in its prevention, early detection and management. 相似文献
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Corneal graft rejection is the major cause of penetrating keratoplasty failure. It is a complex immunological process that involves recognition of alloantigens from the corneal graft by the host's immune system, leading to an efferent immune response against the graft. Each layer of the cornea can undergo rejection, endothelial rejection being the most severe form. In some cases, rejection will lead to corneal graft failure. Many donor- and host-related risk factors contribute to corneal graft rejection. Corticosteroid therapy, topical or systemic, is the gold-standard in the preventive and curative treatment of rejection. Other immunosuppressive agents are promising but require further evaluation. Early detection of rejection is essential to establish an aggressive treatment and reduce the risk of graft failure. Prevention of rejection is also based on tissue matching between donor and recipient. In high-risk patients, ABO compatibility decreases the risk of rejection. HLA compatibility could positively influence corneal graft survival in some cases. 相似文献