抗体介导的小鼠肾移植急性排斥反应动物模型

抗体介导的排斥反应(AMR)是影响远期移植肾存活的首要原因,相关领域的研究正成为热点。小鼠肾移植急性AMR模型可应用于研究移植肾AMR的发生机制、诊断标识、预防和治疗策略。目前国际上已报道数种小鼠肾移植急性AMR模型的建立方法,但国内尚缺乏相关研究。本文对小鼠肾移植急性AMR模型的建立方法作一总结,并对该模型的特点及未来可能的发展趋势加以探讨,为需要应用这一模型的研究者提供参考。     

肾移植术后西罗莫司的应用方案选择

本综述总结西罗莫司用于预防肾移植术后排斥反应的各种用药方案,从急性排斥发生率、肾功能、人/肾存活率4个方面综合比较各种用药方案同其他传统免疫抑制方案的优劣。综合比较显示,肾移植术后转换使用西罗莫司是最值得推荐的用药方案。在环孢素与西罗莫司联用（CsA＋SRL）过程中减、停环孢素也是可以考虑的方案,但要注意控制西罗莫司浓度。西罗莫司可以替换麦考酚酸酯,此时钙调神经蛋白抑制剂（CNI）应适当减量。起始低剂量西罗莫司与CNI联用（CNI＋SRL）,以及起始足量CNI＋SRL并维持、起始不含CNI以及术后移植肾功能延迟恢复（DGF）过渡期使用西罗莫司均应当避免。西罗莫司支持术后撤停激素,此种情况下推荐西罗莫司与他克莫司联用。需定期监测西罗莫司谷浓度,并多数情形下推荐使用首剂负荷剂量。     

移植肾上尿路结石的腔内治疗

目的评估内镜治疗肾移植术后尿路结石的疗效。方法 5例肾移植并发上尿路结石患者接受了内镜手术治疗。其中肾结石2例,输尿管结石3例（其中输尿管膀胱吻合口狭窄并结石1例,金属支架结石2例）。结石最大直径11~52mm,发病时间为接受肾移植术后10个月~6年。结果 2例肾结石及1例金属支架结石患者接受钬激光经皮肾镜碎石取石术成功,2例输尿管结石行输尿管镜取石成功。无一例患者出现严重并发症。结论微创内镜手术在治疗移植肾术后并发尿路结石具有良好的效果。     

以西罗莫司为基础环孢素A早期减量和撤除方案对比的临床观察

目的:评价以西罗莫司(SRL)为基础,环孢素(CsA)早期减量和撤除的免疫抑制方案在肾移植患者中的疗效和安全性.方法:2004年7月～2005年9月间17例肾移植患者使用SRL CsA 激素的免疫抑制方案.术后第3个月,使SRL浓度在4～12μg/L,同时逐渐减少CsA用量;至术后第6～9个月,使CsA浓度降至50～100 ng/ml或停用CsA,SRL浓度维持在6～12μg/L(减量者)或8～15μg/L(停CsA者).术后定期监测血肌酐(SCr)水平,观察不良反应及人、肾存活情况.结果:13例于术后第6～9个月完成CsA减量(mCsA,10例)或撤除(eCsA,3例)方案,10例mCsA患者的CsA用量由(4.6±0.71)mg/(kg·d)减至(2.9±1.10)mg/(kg·d)(P＜0.05).术后2年,患者和移植肾全部存活,各有3例、5例分别维持eCsA和mCsA方案,CsA用量减至(1.1±0.26)mg/(kg·d).完成并维持eCsA和mCsA方案的患者,术后第12、24个月的SCr分别为(101±32.7)μmol/L(n=10)、(101±25.8)μmol／L(n=8).1例在CsA减量前发生急性排斥(AR),1例CsA减量后因自行停用SRL发生AR.主要不良反应有高脂血症(n=11)、肝功能损害(n=7)和感染(n=7)等.结论:以西罗莫司为基础用药而减少或停用CsA,可有效防治AR,同时可减少CsA的肾毒性等不良反应.高脂血症和肝功能异常等是主要不良反应,西罗莫司的不良反应及对停用CsA的疑虑会影响该方案的实施.     

小鼠移植肾再次移植动物模型的建立

目的探讨小鼠移植肾再次移植动物模型建立方法。方法将首次移植供体小鼠左侧供肾肾静脉(RV)同首次移植受体小鼠肾下下腔静脉(IVC)端侧连续吻合,首次移植供体小鼠左侧供肾肾动脉(RA)连带小段首次移植供体小鼠腹主动脉(AO)同首次移植受体小鼠AO端侧间断吻合,首次移植供体小鼠左侧供肾输尿管拖入并固定在首次移植受体小鼠膀胱顶后壁完成小鼠首次肾移植术。首次移植术后2~4周,将首次移植受体小鼠体内移植肾脏RV连带部分首次移植受体IVC同移植肾再次移植受体小鼠IVC端侧连续吻合,移植肾脏RA连带小段首次移植供体和受体小鼠AO同移植肾脏再次移植受体小鼠AO端侧间断吻合,将再次移植肾输尿管拖入并固定在再次移植受体小鼠膀胱顶后壁完成小鼠移植肾再次肾移植术。首次移植和移植肾再次移植术中均切除受体双侧自体肾脏。记录手术时间,随访移植肾再次移植受体存活,监测再次移植肾功能和病理。结果移植肾再次移植供体手术时间为(50±10)min,受体手术时间为(55±5)min。共完成8例小鼠移植肾再次移植术。2例同系,6例非同系。第1例尝试性非同系移植肾再次移植受体存活11 d。后续5例非同系移植肾再次移植受体中1例存活21 d,其余4例均存活到术后70 d获取标本。2例同系移植肾再次移植受体均存活到术后30 d获取标本。8例移植肾再次移植受体在获取标本时或非预期死亡前血清肌酐均<0.2 mg/dl。苏木精-伊红(HE)染色提示同系移植肾再次移植术后30 d移植肾未见病理性改变。结论本文描述了建立小鼠移植肾再次移植动物模型的方法,为开展移植免疫相关研究提供了新手段。     

改良大鼠完全去胸腺免疫模型的建立

Objective To establish a stable adult completely thymectomized rat model under the premise of not injuring the removed thymus tissue. Methods Adult SD ♂ rats weighing 150-300 g ( n = 30) were no-invasively intubated under the help of an improved self-made wedge tube set made from a 2 ml plastic syringe and transillumination in front of the rats' neck by an operation spotlight, then the rats were completely thymectomized under ventilation by a small animal breathing machine and × 10 operating microscope. Whether the exsected thymus organ was ntact or not during operation was confirmed, and sur-vival rate of rats was observed, and changes of PBMC T cell reservoir from randomly selected 9 of 30 rats were monitored by FCM within 3 weeks pest-operation. The complete thymectomy rate was confirmed by autopsy and histological examination 3 weeks post-operation. Results The survival rate was 100%, the exsected thymus organ was intact,and the complete thymectomy rate was 100%. Conclusion Completely thymectomized adult rats model can be successfully established in the condition of keeping exsected thymus tissue intact by using a small animal breathing machine under × 10 operating microscope. The removed thymus tissue can be used for transplantation.     

活体肾移植预后危险因素分析

我国活体肾移植目前尚处于发展阶段,临床经验有待进一步积累.本研究拟回顾性分析我院2004年2月-2007年9月66例活体肾移植资料,探讨影响活体肾移植患者预后的危险因素.     

多瘤病毒BK研究的新进展

自1971年首次报道多瘤病毒家族成员BK病毒(BKV)以来,随着研究的不断深入,已证实BKV跟临床上多种疾病相关。BKV已引起临床上特别是肾移植领域的更多的关注。本文对近5年来对BKV研究的主要新进展作一综述。     

改良大鼠完全去胸腺免疫模型的建立

Objective To establish a stable adult completely thymectomized rat model under the premise of not injuring the removed thymus tissue. Methods Adult SD ♂ rats weighing 150-300 g ( n = 30) were no-invasively intubated under the help of an improved self-made wedge tube set made from a 2 ml plastic syringe and transillumination in front of the rats' neck by an operation spotlight, then the rats were completely thymectomized under ventilation by a small animal breathing machine and × 10 operating microscope. Whether the exsected thymus organ was ntact or not during operation was confirmed, and sur-vival rate of rats was observed, and changes of PBMC T cell reservoir from randomly selected 9 of 30 rats were monitored by FCM within 3 weeks pest-operation. The complete thymectomy rate was confirmed by autopsy and histological examination 3 weeks post-operation. Results The survival rate was 100%, the exsected thymus organ was intact,and the complete thymectomy rate was 100%. Conclusion Completely thymectomized adult rats model can be successfully established in the condition of keeping exsected thymus tissue intact by using a small animal breathing machine under × 10 operating microscope. The removed thymus tissue can be used for transplantation.     

改良大鼠完全去胸腺免疫模型的建立

Objective To establish a stable adult completely thymectomized rat model under the premise of not injuring the removed thymus tissue. Methods Adult SD ♂ rats weighing 150-300 g ( n = 30) were no-invasively intubated under the help of an improved self-made wedge tube set made from a 2 ml plastic syringe and transillumination in front of the rats' neck by an operation spotlight, then the rats were completely thymectomized under ventilation by a small animal breathing machine and × 10 operating microscope. Whether the exsected thymus organ was ntact or not during operation was confirmed, and sur-vival rate of rats was observed, and changes of PBMC T cell reservoir from randomly selected 9 of 30 rats were monitored by FCM within 3 weeks pest-operation. The complete thymectomy rate was confirmed by autopsy and histological examination 3 weeks post-operation. Results The survival rate was 100%, the exsected thymus organ was intact,and the complete thymectomy rate was 100%. Conclusion Completely thymectomized adult rats model can be successfully established in the condition of keeping exsected thymus tissue intact by using a small animal breathing machine under × 10 operating microscope. The removed thymus tissue can be used for transplantation.