免疫和非免疫因素在角膜移植片慢性失功中的作用

目的利用小鼠角膜移植片慢性失功（CCAD）模型研究免疫和非免疫因素在CCAD发生发展过程中的作用。方法分别以C57BIM6（异系）、CB6F1（F1代）、BALB／c（同系）小鼠为供体,以BALB／c小鼠为受体进行穿透角膜移植,健康BALB／c小鼠为对照组。术后对角膜移植片进行评分;免疫组织化学法检测各组移植片CD4‘T淋巴细胞、F4／80、TGF—G、碱性成纤维细胞生长因子（bFGF）、d平滑肌肌动蛋白（d．SMA）表达;手术后1、2、3个月采用反转录PCR法检测各组小鼠角膜移植片中F4／80和TGF—B表达情况。结果异系移植组发现典型的临床免疫排斥反应并有移植片混浊,F1代和同系移植组小鼠移植片未发现临床可见的急性排斥反应而移植片透明度随时间逐渐下降,对照组角膜始终透明。异系移植组移植片基质中见大量CD4^＋T淋巴细胞浸润;F1代移植组和同系移植组偶见CD4^＋T淋巴细胞浸润,对照组未见CD4^＋T淋巴细胞。各组角膜基质内均可见F4／80、TGF—B、bFGF阳性表达,阳性表达量随着各组免疫原性减弱而降低。术后早期各移植组F4／80表达量低,晚期表达量增高,对照组F4／80未见表达;而TGF—B各移植组早期表达量较多,晚期表达量下降,对照组各时间点均为低表达。异系移植组和F1代移植组角膜移植片发生混浊时,基质内可见d-SMA阳性表达,同系移植组呈弱阳性表达,对照组未见阳性表达。结论穿透角膜移植术后抗原依赖的免疫细胞浸润和非抗原依赖的细胞因子异常表达都参与了角膜移植片慢性失功的过程。     

小肠移植术后慢性移植物失功1例报道及文献复习

目的探讨小肠移植术后慢性移植物失功(chronic graft dysfunction,CGD)的诊断及治疗。方法报道国内首例同种异体小肠移植患者术后CGD的临床资料,复习相关文献。结果患者因"门静脉血栓、脾静脉血栓致肠系膜血栓"切除了大部分小肠,后行同种异体小肠移植术。术后长期服用他克莫司(FK506),屡次发生排斥反应。术后3次因"小肠狭窄、不全性肠梗阻"行"小肠节段切除吻合术"。其中术后576d第3次出现肠梗阻,予经皮内镜下胃空肠造瘘术胃肠减压等治疗,确定移植肠不可逆性失功后行移植小肠切除术。结论 CGD治疗困难,预后不佳,预防胜于治疗。在确诊CGD不可逆后应尽快切除移植小肠,挽救患者生命,有条件应尽快安排再次移植。     

再次肝移植的原因与预后分析

目的探讨再次肝移植的原因和预后。方法回顾性分析2003年11月26日至2012年5月26日期间笔者所在医院行再次肝移植215例患者的临床资料,分析其再次肝移植的原因与预后。结果笔者所在医院完成再次肝移植215例,其中行2次肝移植200例,3次肝移植14例,4次肝移植1例。第2次肝移植的主要原因为胆道并发症（53.5%,115/215）,其次为肝移植物原发性无功能或功能低下（8.4%,18/215）;第3次肝移植的原因主要为胆道并发症（5/14）,其次为肝癌复发（2/14）。早期（肝移植术后1个月内）与后期（肝移植术后1个月后）第2次肝移植移植物生存率比较差异有统计学意义（P=0.005）,后期第2次肝移植移植物生存率较高。第3次肝移植移植物生存率低于第2次肝移植（P=0.043）。与胆道并发症者比较,肝癌复发者（P=0.001）和肝移植物原发性无功能或功能低下者（P=0.033）移植物生存率较低,慢性移植肝失功能者移植物生存率较高（P=0.037）。结论胆道并发症为再次肝移植的最主要原因。移植后早期行再次肝移植的效果不佳,其主要原因是围手术期的死亡增加。因肝癌复发而行再次肝移植患者移植物的预后不理想,而慢性移植肝失功能患者移植物的预后最佳。     

再次肝移植6例报道及文献复习

目的 总结再次肝移植的临床经验.方法 对6例患者施行再次肝移植,再次肝移植的原因分别为原发性移植肝无功能(2例)、排斥反应(2例)、胆管吻合口狭窄(1例)以及原发性硬化性胆管炎(1例).供肝植入采用背驮式及经典原位肝移植术; 术后免疫抑制治疗采用他克莫司(tacrolimus)、吗替麦考酚酯(MMF)和激素三联免疫抑制方案.结果 5例治愈,已分别存活16个月、11个月、8个月、5个月及2个月,1例于术后第4 天死于多器官功能衰竭.术后并发症有深部真菌感染及切口感染.结论 再次肝移植是移植肝功能衰竭的有效治疗方法,适应证及手术时机的正确把握、围手术期的严密监测和正确处理是提高再次肝移植患者存活率的关键.     

大鼠同种异体穿透性角膜移植排斥模型的建立与评价

目的:远交系Wistar大鼠与SD大鼠行穿透性角膜移植,评价其作为角膜移植排斥模型的可行性,并总结操作体会、技术特征。方法:Wistar大鼠右眼作为受体,SD大鼠双眼作为供体,行穿透性角膜移植,供体角膜植片靠近角膜缘取材,受体术后保留缝线,观察角膜移植排斥反应发生的进程。结果:异体角膜移植组排斥反应在术后(9.65±0.77)天出现,排斥反应发生率100%;自体角膜移植组无排斥反应发生。两组80例模型术后并发症:瞳孔不圆9例,虹膜前粘连6例,白内障4例,眼内感染3例,虹膜脱出3例。结论:远交系Wistar大鼠和SD大鼠行穿透性角膜移植,可作为角膜移植排斥模型用于模拟人类角膜移植排斥反应进行相关临床和基础研究。选择MHC抗原差异大的品系、偏中心植片及保留缝线等方法可增加角膜排斥反应的发生率。熟练的显微手术技巧、锐利的手术器械、术前充分散瞳及术后前房形成是减少术后并发症的关键。     

角膜移植排斥反应过程与后继内皮细胞再生及重建

角膜是数量最为庞大的移植物，仅美国每年就有50000余例角膜移植。角膜移植曾被认为属于“免疫赦免”范畴，其原因涉及移植物自身的免疫原性较低、缺乏抗原呈递细胞、缺乏血管和淋巴管、供体组织能够很快被受体组织取代等。但是，在临床上具有代表性的高危角膜移植（移植前角膜曾有过炎症、角膜床有血管化表现、再次移植等等）的排斥反应发生率为40％-65％，而且排斥反应一旦发生，则49％的病例不可恢复。     

白细胞介素2-绿脓杆菌外毒素抑制小鼠角膜移植后的排斥反应

目的 观察白细胞介素2-绿脓杆菌外毒素(IL-2-PE40)对小鼠角膜移植排斥反应的抑制作用.方法 以C57BL/6小鼠为供者,Balb/c小鼠为受者,制备小鼠同种异体穿透性角膜移植模型,治疗组受者于手术当天起腹腔注射IL-2-PE40,用量为0.6μg/g,每12 h 1次,直至排斥反应发生;对照组相应时间点腹腔注射等体积生理盐水.术后每周在裂隙灯下观察移植角膜2次,根据Hori等的分级标准,对移植角膜混浊和新生血管进行分级,判断排斥反应发生情况,发生排斥反应时判定为移植角膜存活终止;并在术后第10、15、25、35天分别取术眼,行组织学观察,同时收集外周血,测定T淋巴细胞亚群及T淋巴细胞集落形成数.结果 治疗组与对照组移植角膜存活时间分别为(30.2±2.9)d和(15.1±2.1)d,对照组于术后第15天出现排斥反应;术后对照组CD4~+细胞开始升高,于第15天升高最为明显,达(63.9±4.0)%,随后下降,而治疗组CD4~+细胞仅轻微上升,第15天为(42.6±4.0)%,明显低于对照组(P<0.01);术后2个组CD8~+细胞变化不大;术后对照组T淋巴细胞集落形成数呈先升后降趋势,第15天上升最为明显,为(296±17)个,随后下降,而治疗组的变化不明显,第15天为(201±16)个,明显低于对照组(P<0.01).结论 IL-2-PE40可推迟角膜移植排斥反应的发生时间;能明显减少外周血中辅助性T淋巴细胞的作用,并能减弱小鼠外周血T淋巴细胞集落形成能力.     

性激素对慢性移植肾失功影响的研究进展

性激素对人体机能有多方面的调控作用,已有研究表明性激素会影响慢性移植物失功的进展.本文综合近年来有关这方面的研究作一综述,旨在为更深一步的临床研究提供参考.     

我国角膜移植领域面临的困难与挑战

角膜移植是目前组织器官移植手术中成功率最高的手术。近20年来,我国角膜移植的手术量增多,技术水平也明显提高,但存在的问题也很突出,如供体来源不足,成分角膜移植导致的新问题,对角膜移植后排斥反应了解很少等,这些问题对我国角膜移植基础研究和临床工作提出了挑战。     

Etiology and pathophysiology of chronic transplant dysfunction

Chronic transplant dysfunction (CTD) is the predominant cause of late graft failure. The common histopathological feature in all transplanted organs is intimal hyperplasia accompanied by organ specific lesions. The knowledge about CTD is incomplete, and there is no therapy to prevent or treat it. This review describes the current knowledge on the etiology of CTD, with emphasis on kidney transplants, and postulates a pathophysiologic route through which CTD may develop. Received: 2 August 1999 Revised: 11 April 2000 Accepted: 27 June 2000     

Does delayed kidney graft function increase the risk of chronic rejection?

Abstract  The impact of delayed graft function (DGF) on later renal graft loss due to chronic rejection was studied in a single center using uniform protocol for organ procure merit and post transplant patient care. DGF function was observed in 34 % of 829 consecutive first cadaveric renal transplants in adults and in 47 % of 169 retransplantations (P < 0.05). There were no significant differences in graft survival between groups with early graft function (EGF) and DGF, either in first transplantations or retransplantations. The half-life in EGF and DGF groups of first transplants was 12.3 years and 10.5 years, respectively, and of retransplantants was 8.0 years and 6.5 years, respectively. DGF was divided in three subgroups according to the day of onset. If graft function started during the first or second week after transplantation there were no significant differences in long-term graft survival rates compared with EGF. Only in re-transplants, if graft function started later than 2 weeks postoperatively, were long-term graft survival rates significantly lower when compared with EGF and the difference persisted if other causes of graft loss except chronic rejection were censored.     

Systemic mycophenolate mofetil avoids immune reactions in penetrating high-risk keratoplasty: preliminary results of an ongoing prospectively randomized multicentre study.

Recently, in a monocentre study mycophenolate mofetil (MMF) was demonstrated to be efficacious and safe in penetrating high-risk keratoplasty. Here, preliminary results of a randomized multicentre trial are presented. To date, 86 of 140 scheduled patients undergoing high-risk penetrating keratoplasty have already been randomized into the two study groups: 48 into the MMF group and 38 into the control group. All 86 patients received fluocortolon 1 mg/kg body weight/day, tapered within 3 weeks, and topical prednisolone acetate 1% tapered within 5 months. MMF was administered at a daily oral dose of 2 x 1000 mg for the first 6 postoperative months. Thereafter, MMF was tapered within 2 weeks. The proportion of grafts with immune reactions and side-effects were the main outcome measures. Within an average follow up of 9.2 +/- 6.6 months two patients developed reversible endothelial immune reactions in the MMF group after cessation of MMF application. In the control group, five reversible and three irreversible immune reactions were observed within an average follow up of 10.1 +/- 7.6 months. According to Kaplan and Meier analysis, the ratio of grafts without immune reactions was estimated 89% 1 year postoperatively in the MMF group, in contrast to only 67% in the control group (P = 0.03; log-rank test). Fifteen patients experienced side-effects, especially gastroenterotoxicity, tachycardia, arthralgia or systemic infections. All attributable side-effects were reversible. Systemic MMF may be an effective and safe immune modulating drug in the prophylaxis of immune reactions after penetrating high-risk keratoplasty.     

Live donor kidney transplantation in India: effects of donor and recipient age on graft survival

Introduction: The increasing gap between demand and supply of human kidneys has resulted in the use of more expanded criteria donor organs are used. The influence of age on short- and long-term survival of renal allograft has not been well studied in Indian population. Materials and methods: Two hundred and seventy-eight patients were evaluated retrospectively who underwent kidney transplantation from Jan 2008 to June 2011. Patients were divided into 6 groups: group A (donor age 20–40 years, recipient age <50 years), group B (donor age 20–40 years, recipient age >50 years), group C (donor age 40–60 years, recipient age <50 years), group D (donor age 40–60 years, recipient age >50 years), group E (donor age >60 years, recipient age <50 years) and group F (donor age >60 years, recipient age >50 years). Uni-variate analysis was used to assess the effect of donor and recipient age as predictive factors for graft outcome, using the Kaplan–Meier method (log-rank) with p?Results: Graft survival was found to be lowest in elderly recipients and in patients with donor age >60 years. Renal function was superior using younger donors both in short and long term. The incidence of acute rejection was found to be lower in elderly donor group than in younger, although the difference was not statistically significant. Conclusion: Donor’s higher age did not show significant impact on allograft survival although, kidney allografts demonstrated decreased short and long term renal function.     

Indications, complications and prognosis for repeat penetrating keratoplasty.

A review of 47 repeat penetrating keratoplasties in 29 eyes showed the most frequent indications to be Fuchs' dystrophy, bullous keratopathy, and keratoconus. The most common postoperative complications were edema, glaucoma, and vascularization. Ninety other surgical procedures were performed in 26 of the 29 eyes. Final vision was no worse than 20/300 in 26% of the group. It is suggested that repeat grafting should be continued in the absence of contraindications.     

糖尿病与勃起功能障碍病因研究进展

糖尿病 (DM)是勃起功能障碍 (ED)的危险因子之一。DM性ED病人阴茎组织出现以下病理变化 :平滑肌、内皮细胞退变 ,白膜增厚 ,血管及周围神经递质发生改变     

女性性功能障碍的常见病因

女性的性功能障碍是一种常见和多发疾病,给夫妻生活带来显著的不良影响,而明确其病因是合理诊治的基础。本文介绍了女性性功能障碍的常见病因,主要包括心理与社会因素、神经因素、性激素异常、疾病因素、药物因素和产后。     

儿童慢性胰腺炎的病因及内镜在治疗中的价值

目的探讨儿童慢性胰腺炎的病因和十二指肠镜在治疗中的价值。方法回顾性分析2006～2011年18例18岁以下因慢性胰腺炎行ERCP 40次的临床资料。年龄4～17岁,平均10.3岁。男8例,女10例,均存在上腹痛,影像学检查提示胰腺有异常表现。气管插管全麻下行ERCP。行狭窄括约肌切开、胰管狭窄段扩张、碎石、取石、胰管支架放置/鼻胰引流管放置等治疗。结果 18例40次ERCP操作,胰管插管成功39次（97.5%）。不明原因慢性胰腺炎11例（61.1%,其中2例以胰腺胸膜瘘发病）,胰腺结构异常致慢性胰腺炎7例。全部患者症状消失。ERCP无严重并发症。9例结束治疗者随访1～39个月,均无腹痛发作。结论儿童慢性胰腺炎病因主要为特发性及结构异常,经十二指肠镜治疗微创、安全、有效。     

无晶体眼二次穿透角膜移植后并发迟发性脉络膜上腔出血1例

迟发性脉络膜上腔出血是角膜移植术后罕见的并发症,一旦发生对预后影响较大。山东省千佛山医院眼科于2010年成功诊治了1例无晶体眼状态下行二次角膜移植术后并发迟发性脉络膜上腔出血患者,现报道如下。