肾移植术后远期急信排斥反应与巨细胞病毒感染

目的 探讨肾移植术后远期急性排斥反应与巨细胞病毒感染的关系。方法 检测４５例移植肾有功能存活１年以上后发生急性排斥反应者外周血白细胞中巨细胞病毒ＤＮＡ（ＣＭＶ ＤＮＡ），并给予激素冲击治疗，对激素冲击无效的部分患者给予更昔洛韦抗病毒治疗。结果 ３２例激素冲击有效，１３例无效。无效者外周血白细胞内可测到ＣＭＶ ＤＮＡ，８例用更昔洛韦治疗后ＣＭＶ ＤＮＡ转阴，２例肾功能好转，６例恢复正常，另５例未用更     

肾移植术后巨细胞病毒感染与排斥反应

人类巨细胞病毒（HCMV）感染是免疫抑制状态下的器官移植受者常见而严重的并发症.肾移植术后巨细胞病毒感染和排斥反应是密切相关的两过程,并通过产生一系列相似的细胞因子、化学因子和生长因子共同作用于移植肾,导致移植肾功能丧失.     

肾移植术后巨细胞病毒感染与排斥反应

人类巨细胞病毒(HCMV)感染是免疫抑制状态下的器官移植受者常见而严重的并发症。肾移植术后巨细胞病毒感染和排斥反应是密切相关的两过程,并通过产生一系列相似的细胞因子、化学因子和生长因子共同作用于移植肾,导致移植肾功能丧失。     

肾移植受者人巨细胞病毒感染与排斥反应的关系

采用聚合酶链反应技术及酶联免疫吸附法检测人巨细胞病毒感染，以ＨＣＭＶ感染与排斥反应的关系。６５例肾移植受者中ＨＣＭＶ感染者３９例，其排斥的发生率为４８．７％，未感染组则为１５．４％。对未发生排斥反应的１５对肾移植患者进行配对研究，结果表明：ＨＣＭＶ感染组排斥发生率为４０％；未感染组则为１３．３％，Ｐ〈０．０１。     

重症巨细胞病毒感染和急性排斥肾移植受者T淋巴细胞亚群的动态变化

目的：探讨肾移植受者外周血Ｔ淋巴细胞亚群与发生重症巨细胞病毒（ＣＭＶ）感染和急性排斥反应（ＡＲ）之间的关系。方法：采用ＣＯＵＬＴＥＲ公司生产的鼠抗人Ｔ淋巴细胞亚群单克隆抗体ＯＫＴ系列及ＥＬＩＴＥ型流式细胞仪对２３例重症ＣＭＶ感染者、８例ＡＲ患者和２０例正常肾移植者的外周血Ｔ淋巴细胞亚群进行动态测定。结果：术后无ＡＲ者与ＡＲ者、排斥反应缓解者与未缓解者,其ＣＤ４／ＣＤ８比值变化差异有显著性意义（Ｐ〈     

肾移植术后的巨细胞病毒感染及其对急性排斥反应的影响

目的 探讨肾移植受者术后活动性巨细胞病毒（ＣＭＶ）感染的发生率、感染的原因以及ＣＭＶ感染对急性排斥反应的影响。方法 检测１８７例肾移植受者和供者术前血清抗－ＣＭＶ抗体;受者术后定期检测体内ＣＭＶ ＤＮＡ、对ＣＭＶ ＤＮＡ阳性的部分患者给予抗ＣＭＶ治疗,并比较各组排斥反应的发生率。结果 无论是供者还是受者,术前如血清抗－ＣＭＶ抗体阳性,受者术后发生活动性ＣＭＶ感染者明显增多,这些患者急性排斥反应的发     

HLA-G与肾移植术后急性排斥反应和巨细胞病毒活动性感染的相关性研究

目的 探讨HLA-G的表达水平与肾移植术后急性排斥反应(AR)和巨细胞病毒(CMV)活动性感染的相关性.方法 根据术后是否发生AR或CMV活动性感染,将132例初次肾移植受者分为肾功能稳定组、AR组和CMV组.另选择41例健康供者作为对照组.采用流式细胞术、酶联免疫吸附试验、蛋白质印迹法以及实时定量聚合酶链法检测各组HLA-G及其mRNA的表达,并采用免疫组织化学法观察移植肾组织中HLA-G的表达.结果 肾移植前后各组膜结合型HLA-G1 (mHLA-G1)的表达均处于较低水平,仅术后CMV组mHLA-G1+的中性粒细胞出现显著升高(P＜0.05).术前可溶性HLA-G5(sHLA-G5)的表达水平肾功能稳定组显著高于对照组(P＜0.05);术后sHLA-G5的表达水平CMV组显著高于肾功能稳定组(P＜0.05),而肾功能稳定组均高于对照组和AR组(P＜0.05),AR组与对照组的差异无统计学意义(P＞0.05).术后CMV组sHLA-G5 mRNA的表达水平最高(P＜0.05),肾功能稳定组次之,对照组和AR组均较低.21例AR组移植肾组织活检样本中,17例HLA-G表达呈阴性,3例呈阳性,1例呈弱阳性;9例CMV组移植肾组织活检样本的HLA-G表达均为阳性.132例受者中,28例CMV感染者的AR发生率为7.1％(2/28),104例非CMV感染者的AR发生率为25.0％(26/104),二者间AR发生率的差异有统计学意义(P＜0.05).结论 sHLA-G5可作为预测AR和CMV感染的生物标志分子;CMV感染和AR与受者体内的免疫平衡状况相关.     

肾移植术后应用FK506抗排斥治疗的临床研究

目的　观察ＦＫ５０６ 在肾移植术后抗排斥治疗的效果及副作用。　方法　对肾移植术后单独应用环孢素Ａ（ＣｓＡ）５０ 例和术后应用ＦＫ５０６ ５０ 例（ 术后２４ 小时应用ＦＫ５０６ ４０ 例,ＣｓＡ 中毒后改ＦＫ５０６ １０ 例）患者进行比较。　结果　ＣｓＡ 组发生急性排斥反应（ＡＲ）９ 例,发生率为１８ ％ ,逆转８ 例（８８ ％） ,肾功能在２ ～２６ 天恢复正常３８ 例（７６ ％） ,肺部感染２ 例,泌尿系感染１ 例,肾中毒２例,肝中毒３ 例,高血糖２ 例,腹泻１ 例,摘肾１ 例。ＦＫ５０６ 组ＡＲ４ 例均逆转,肾功能２～１３ 天恢复正常４０ 例（８０％ ）,高血糖１４ 例（２８％ ）,肾中毒２ 例,肝中毒１ 例,腹泻２２ 例（４４％ ）,１ 例因肺部感染、高血糖难以控制仍改用ＣｓＡ。应用ＣｓＡ 肝中毒的１０ 例患者改用ＦＫ５０６ 后肝功能７ ～１６ 天全部恢复正常。　结论　肾移植术后应用ＦＫ５０６ 安全有效,排斥率明显降低,副作用小,但对长期存活的影响及并发症还需进一步观察。     

ICAM-1和VCAM-1测定在肾移植急性排斥反应中的临床意义

目的探讨血清可溶性细胞间粘附分子１（ｓＩＣＡＭ１）和可溶性血管细胞粘附分子１（ｓＶＣＡＭ１）在肾移植急性排斥反应中的临床意义。方法采用酶联免疫吸附法（ＥＬＩＳＡ）动态监测５６例肾移植患者术后ｓＩＣＡＭ１和ｓＶＣＡＭ１水平的变化。结果肾移植患者术后ｓＩＣＡＭ１和ｓＶＣＡＭ１水平呈规律性变化,急性排斥反应组ｓＩＣＡＭ１为（３９０．６±９１．０）ｎｇ／ｍｌ,ｓＶＣＡＭ１为（１９５７．１±４０３．１）ｎｇ／ｍｌ,明显高于移植肾功能稳定组的（１３７．３±１６．８）ｎｇ／ｍｌ、（１１１８．４±２１０．４）ｎｇ／ｍｌ和ＣｓＡ肾中毒组的（１３２．７±２４．８）ｎｇ／ｍｌ、（１２８５．８±２７０．５）ｎｇ／ｍｌ,差异有非常显著性（Ｐ＜０．０１）。结论ｓＩＣＡＭ１和ｓＶＣＡＭ１可以作为肾移植术后急性排斥反应的免疫学监测指标。     

肾移植术后巨细胞病毒感染的防治

巨细胞病毒(CMV)属于B疱疹病毒家族，为双链DNA病毒。据报道，肾移植受者中约50％～70％有活动性CMV感染，其中10％～30％为有症状性感染。因为其病情凶险，发展迅速，病死率高，是降低受者和移植肾存活率的重要因素，所以有效的预防和治疗极其重要。     

肾移植一年后急性排斥反应时移植肾组织中C4d表达阳性的临床研究

Objective To analyze C4d deposition in the patients with late acute renal allograft rejection,and explore the role of C4d in grafts survival and grafts loss. Methods Thirty-six patients clinical and pathologically diagnosed as having acute rejection more than one year post-transplant were selected. C4d was detected by immunohistochemistry in renal allograft biopsies. The effect of C4d deposition on long-term graft survival was studied. Results Among 36 recipients with late acute renal allograft rejection, 16 cases were positive for C4d (44.4 %) and 20 negative for C4d (55.6 %). Five cases experienced graft loss in C4d positive group (31.3 %), while 6 cases in C4d negative group (30.0%). There was no significant difference in the graft loss rate between C4d-positive group and C4d-negative group. Log-Rank test demonstrated there was no significant difference in graft survival between C4d-positive group and C4d-negative group. The count of the interstitial infiltrated eosinophils in renal allograft was (9.4 + 4.5) and (2.6 + 1.8) respectively in the C4d-positive group and C4dnegative group (P＜0.05). Conclusion C4d deposition in peritubular capillary of the recipients with late acute renal allograft rejection might not be a prognostic marker for graft outcome.     

肾移植一年后急性排斥反应时移植肾组织中C4d表达阳性的临床研究

Objective To analyze C4d deposition in the patients with late acute renal allograft rejection,and explore the role of C4d in grafts survival and grafts loss. Methods Thirty-six patients clinical and pathologically diagnosed as having acute rejection more than one year post-transplant were selected. C4d was detected by immunohistochemistry in renal allograft biopsies. The effect of C4d deposition on long-term graft survival was studied. Results Among 36 recipients with late acute renal allograft rejection, 16 cases were positive for C4d (44.4 %) and 20 negative for C4d (55.6 %). Five cases experienced graft loss in C4d positive group (31.3 %), while 6 cases in C4d negative group (30.0%). There was no significant difference in the graft loss rate between C4d-positive group and C4d-negative group. Log-Rank test demonstrated there was no significant difference in graft survival between C4d-positive group and C4d-negative group. The count of the interstitial infiltrated eosinophils in renal allograft was (9.4 + 4.5) and (2.6 + 1.8) respectively in the C4d-positive group and C4dnegative group (P＜0.05). Conclusion C4d deposition in peritubular capillary of the recipients with late acute renal allograft rejection might not be a prognostic marker for graft outcome.     

Rat cytomegalovirus infection and chronic kidney allograft rejection

Abstract  To investigate the effect of cytomegalovirus (CMV) infection on the development of experimental chronic kidney allograft rejection, orthotropic kidney allografts from DA donors (Ag- RTl^al) to WF (Ag- RTl^u) recipients were used. The rats received cyclosporine A (CsA) for 12 weeks. A group of recipients was infected with 10⁵ plaque-forming units of rat CMV (RCMV), and another group was left non-infected and used as controls. The grafts were removed 12 weeks after transplantation. RCMV infection significantly enhanced the development of chronic kidney allograft rejection as follows: the intensity of interstitial inflammation ( P < 0.025), particularly the degree of pyroninophilic cells in the inflammatory infiltrate ( P < 0.025); the glomeruli mesangial matrix increase ( P < 0.05) and capillary basement membrane thickening ( P < 0.01); the extent of endothelial cell swelling ( P < 0.025) and intimae proliferation (P < 0.025) in the graft vasculature; and the extent of tubular epithelial atrophy ( P < 0.025). The chronic allograft damage index (CADI) was significantly increased to 4.2 ± 0.9 in RCMV-infected allograft, compared with 0.8 ± 0.4 in non-infected ( P < 0.02). At the molecular level, RCMV infection significantly increased vascular endothelial ( P < 0.05) and tubular epithelial ( P < 0.01) ICAM-1 expression. Viral antigens were detected in tubular epithelial cells and in some inflammatory cells.     

慢性排斥反应的病因与病理学分析

为探讨慢性排斥（ＣＲ）的病因与病理学，对１１４１例尸肾移植者中５９例接受治疗的ＣＲ病例进行回顾分析。结果：（１）ＣＲ占总病例的５．２％，平均发生于术后２３个月，有急性排斥（ＡＲ）史者２７．１％，免疫抑制药物服用不足者２５．４％，余为不明原因者。免疫抑制不足者中患者擅自减少剂量者７３．３％，经抗排斥治疗及增加药物剂量后肾功正常或稳定者占１８．６％。（２）ＣＲ表现为间质纤维增殖、小淋巴细胞和浆细胞散在浸润；肾小球基底膜增厚，透明样变，血管内膜增厚。结论：（１）ＡＲ是ＣＲ发生的基础；（２）抗排斥与调整免疫抑制药量可挽救部分ＣＲ；（３）雷公藤、百令胶囊治疗ＣＲ有一定疗效；（４）ＣＲ患者中，淋巴细胞毒性低者肾功能更可能得到控制；（５）长期免疫抑制不足是ＣＲ发生的重要原因，按时按量服药可降低ＣＲ发生率。     

肾移植术后特异性感染69例次分析

目的 探索肾移植术后感染发生的规律。方法 回顾分析我院８０８例次肾移植中各种感染的临床资料。结果 ８０８例次肾移植中发生各种感染１８０例次（２０．７％）,死亡３５例（１９．４％）,其中应用硫唑嘌呤和泼尼松者的感染发生率及死亡率较使用以环孢素Ａ为主的三联疗法者为高。已证实感染原的特异性感染６９例次。特异性感染的病原最常见者为病毒。结论 感染是肾移植后的常见并发症,正确调整免疫抑制剂剂量,及时病原诊断     

肾移植受者巨细胞病毒感染及免疫抑制剂对其的影响

目的探讨肾移植受者巨细胞病毒(CMV)感染率及免疫抑制剂对其的影响.方法214例肾移植受者术后给予甲泼尼龙(MP)、抗淋巴细胞球蛋白(ALG)静脉滴注作为免疫诱导治疗.基础免疫抑制剂治疗为环孢素A+泼尼松+硫唑嘌呤.急性排斥反应时给予MP冲击治疗,无效时给予ALG或OKT3治疗.采用免疫细胞化学LSAB法测定外周血白细胞CMV-PP65抗原.结果CMV感染率为61.7%(126/214),初次检出CMV-PP65抗原的时间为术后(25.4±14.7)*!d,平均抗原阳性细胞数为每50000白细胞(9.2±7.9)个.CMV感染的肾移植受者在感染前急性排斥反应率为42.3%(52/126),明显高于无CMV感染受者的20.5%(P<0.01);使用ALG或OKT3治疗例数分别为23、15例,也高于无CMV感染的受者(P<0.05).CMV感染和无CMV感染的肾移植受者ALG免疫诱导治疗疗程分别为(4.7±1.32)*!d、(4.4±0.92)*!d,使用剂量分别为(14.1±1.32)支、(13.2±0.92)支,差异无显著性(P>0.05).结论肾移植术后CMV感染率高;术后短期的ALG免疫诱导治疗可能不增加CMV感染发生率;急性排斥反应发生后免疫抑制剂尤其是ALG或OKT3的使用与术后CMV感染密切相关.     

The impact of pretransplant cytomegalovirus infection on acute renal allograft rejection

BACKGROUND: The role of cytomegalovirus (CMV) infection in renal allograft rejection remains controversial; moreover, there are few studies on pretransplant infections. This study sought to investigate whether pretransplant CMV infections had negative effects on acute rejection episodes (ARE) and to evaluate the effect of preemptive treatment. METHODS: This retrospective single-center study of 416 transplant recipients from October 1, 2000 to September 1, 2003 had CMV infections diagnosed by CMV antigenemia tests. The incidences of ARE were compared between CMV-infected and noninfected groups. Risk factors for ARE were analyzed. Based on preemptive treatment, pretransplant CMV-infected recipients were divided into ganciclovir-treated and nontreated groups and the incidence of ARE was compared between the two groups. RESULTS: One hundred eighty four recipients had CMV infections pretransplant; the infection rate was 44.2%. Fifty five recipients had ARE among the pretransplant CMV-positive group, which was significantly higher than that in the noninfected group (29.9% vs 19.5%, P = .014). But the rejection subgroups and renal function recovery had no significant differences. While the presence of pretransplant infection was an independent predictor of ARE (RR = 1.807), severity showed no significant impact on ARE. Among 184 pretransplant CMV infection recipients, the incidences of ARE were 14.3% and 18.0% in ganciclovir-treated versus nontreated patients, respectively (P = .650). CONCLUSIONS: Pretransplant CMV-positive recipients were at greater risk of ARE. Pretransplant CMV infection was an independent risk factor for ARE. Preemptive antiviral treatment did not show protective effects against ARE related to CMV infection-mediated immunological injuries.     

术前巨细胞病毒感染对移植肾急性排斥的影响

目的 研究肾移植受者术前巨细胞病毒(CMV)感染对术后急性排斥的影响及预防性抗病毒治疗的意义。方法 回顾性分析416例肾移植受者的术前巨细胞病毒感染，预防性抗病毒治疗和急性排斥的发生情况，并用Logistic回归分析各因素对急性排斥的影响。术前感染受者根据有无预防性抗病毒治疗分为治疗组和非治疗组，比较两组间急性排斥发生率。结果术前巨细胞病毒感染组的急性排斥率显著高于非感染组(29．9％比19．5％，P=0．014)，术前感染受者发生急性排斥的风险增高将近1倍。预防性抗病毒治疗能降低术后CMV疾病的发生率但对急性排斥无影响。结论术前巨细胞病毒感染是术后急性排斥独立的危险因子。常规的预防性抗病毒治疗并不能减少由感染介导的免疫损伤而导致的急性排斥的发生。     

小肠移植后亚临床排斥反应的临床病理研究一例

目的 探讨小肠移植后亚临床型细胞性排斥反应(SCR)的临床表现、肠镜下改变和病理特点.方法 小肠移植1例,受者为女性,34岁,供者为男性.应用抗CD52单克隆抗体行诱导治疗,术后单用他克莫司(Tac)、无皮质激素的维持治疗方案.怀疑发生可疑排斥反应(IND)级至I级排斥反应时,提高血Tac浓度,行短程小剂量皮质激素治疗,排斥反应控制不佳时,则行甲泼尼龙冲击治疗;发生中度排斥反应时提高血Tac浓度,给予甲泼尼龙2 g,随后应用皮质激素递减方案.术后头2个月内,每周行2次肠镜和病理学检查,之后频次减为1次/周.结果 至随访结束患者已存活19个月(611 d),期间共发生有临床症状的急性排斥反应6次,亚临床排斥反应3次.3次亚临床排斥反应时,2次肠镜下未见明显改变,1次表现为斑点状的充血、水肿,放大肠镜下绒毛数量轻度减少.3次亚临床排斥反应的病理检查中,1次以黏膜上皮剥脱为主,隐窝上皮损伤较轻,组织学改变符合轻度急性排斥反应;而另2次以隐窝上皮的损伤为主,为可疑急性排斥反应.结论 SCR可能是临床排斥反应的早期阶段,无明显临床症状,肠镜下改变不明显,诊断主要依靠病理学检查,但必须排除移植肠血管病变、肠梗阻、各类炎症等术后并发症.