环孢素治疗丙型肝炎病毒RNA阳性肾移植患者的抗病毒复制效应

背景：丙型肝炎病毒阳性患者接受肾脏移植后,免疫抑制剂的选择及抗丙型肝炎病毒药物的选用是目前关注的重点。 目的：探讨环孢素在丙型肝炎病毒RNA阳性肾移植患者中除抗排斥作用以外的抗病毒复制作用。 方法：纳入11例丙型肝炎病毒RNA阳性肾移植患者,于采用环孢素+咪唑立宾+泼 尼松治疗方案时记为入组,分别对入组前、入组后6,12个月时患者丙型肝炎病毒RNA、血红蛋白、肝肾功能等指标的变化进行检测。 结果与结论：入组前、入组6个月、入组12个月11例患者丙型肝炎病毒RNA中位数(copies/mL)分别为1.22×10⁷,1.11×10⁴,4.19×10⁶;入组6个月时,有8例患者丙型肝炎病毒RNA转阴(丙型肝炎病毒RNA<500 copies/mL),总应答率为73%(8/11);至随访结束,持续病毒学应答率为55%(6/11)。且入组治疗前后患者谷丙转氨酶、血清肌酐、血尿酸水平差异均无显著性意义(P > 0.05),患者血红蛋白水平在入组后升高。随访过程中,仅1例发生排斥反应,甲基强的松龙冲击治疗 3 d后好转。提示对于合并丙型肝炎的肾移植患者,选用环孢素为主的治疗方案,在达到抗排斥治疗作用的同时,可发挥抑制丙型肝炎病毒复制的作用。     

丙型肝炎病毒阳性血清体外感染人肝细胞的研究

目的 研究丙型肝炎病毒(HCV)抗体(Ab)阴性,HCV-RNA阳性血清建立体外感染肝细胞模型.方法 HCV Ab阴性,HCV-RNA阳性的窗口期血清与人肝细胞共同培养,用反转录-聚合酶链反应(RT-PCR)、免疫荧光染色、Western blot、共聚焦显微镜和透射电镜等方法检测细胞内HCV核酸复制、蛋白质表达及超微结构改变.结果 细胞与病毒共同培养7～45 d,细胞内和/或培养上清中可间断检出HCV正、负链RNA;细胞浆内有HCV 核心和NS3抗原的表达;细胞超微结构有改变,并于感染后第24天时观察到类似病毒样颗粒.结论 窗口期血清中的HCV能在人肝细胞7701中复制一段时间.     

从基因分型看血流透析及肾移植患者丙型肝炎病毒…

采用国产和美国Ｏｒｔｈｏ公司第２代抗丙肝炎病毒试剂对１００例维持性血透及肾移植患者进行血清丙型肝炎病毒抗体对比检测。阳性标本用聚合酶键反应法检测ＨＣＶ ＲＮＡ并采用型特异的ＨＣＶ亚基因探针对其非结构蛋白ＮＳ５区扩增产物进行了杂交工基因分型。ｗｃｎｇｔ     

152例重症病毒性肝炎中丙型肝炎病毒感染及其临床分析

１５２例重症病毒性肝炎中丙型肝炎病毒感染及其临床分析胡国龄，谭德明，张铮，任培上有马晖勝丙型肝炎病毒（ＨＣＶ）是肠道外传播的非甲非乙型肝炎的主要病原之一。ＨＣＶ感染易致肝炎慢性化和肝硬化。ＨＣＶ和ＨＡＶ或ＨＢＶ重叠感染可使病情加重，促使重症肝炎的发生...     

肾移植受者排斥反应与外周血T细胞亚群变化

<正> 我们用OKT单克隆抗体(McAb)检测肾移植受者外周血T细胞亚群,并对16例尸体肾移植受者进行分析,其中8例进行手术后(用CsA前),用CsA及时发生排斥(治疗前)时检测比较。另8例较典型病例则分析其排斥反应出现与否以及与T细胞亚群的变化。结果显示OKT检测和临床判断基本相符,提示OKT检测为研究和诊断肾移植受者的急性排斥提供了较好的手段,现报道如下。     

肾移植后急性排斥反应的免疫学监测研究进展

当前肾移植发展十分迅速，但移植后的急性排斥反应，仍然是影响长期存活的重要因素。如何通过非侵入性方法尽早发现急性排斥反应，是人们研究的热点之一。本文就肾移植后急性排斥反应早期免疫学检测指标的研究进展进行综述。     

丙型肝炎病毒RNA在人外周血白细胞中的存在及其意义

丙型肝炎病毒ＲＮＡ在人外周血白细胞中的存在及其意义雷学忠综述王锦蓉、雷秉钧审校本世纪七十年代初，人们就已经注意到一种与输血密切相关的肝炎，而其病原又非甲型或乙型肝炎病毒（ｈｅｐａｔｉｔｉｓＡｏｒＢｖｉｒｕｓ），因此称之为非甲非乙型肝炎（ｎｏｎ－Ａ，ｎ...     

肾移植术后巨细胞病毒抗体IgM／IgA的动脉观察及其临床意义

应用ＢＳＡ－ＥＬＩＳＡ检测４５例肾移植患者手术前后的抗ＣＭＶ ＩｇＭ／ＩｇＡ。结果表明：术前患者抗ＣＭＶ ＩｇＭ和ＩｇＡ的阳性分别为４２．２％和２４．４％，术后随着移植时间的延长其阳性率递增，在术后８周分别达９５．６％和８８．９％和８８．９％，但其发病率仅占１３．９％，分析证明ＣＭＶ感染的发病与排斥反应有关。     

肾脏移植受者HLA体液免疫的研究

通过对２４７８例等待肾脏移植受者的ＨＬＡ体液致敏状态的观察，进行移植受者群体反应性抗体的研究及其与肾脏移植的关联。结果显示，ＰＲＡ是移植前受者是否致敏的指标，与淋巴细胞毒的不相合呈正相关，ＰＲＡ≥３０．００％的受者接受ＣＤＣ阴性移植肾仍然全部发生超急排斥，而ＰＲＡ阴性受者仅为１２．４６％。     

肾移植受者游离血浆中微嵌合体与移植肾免疫耐受的相关性研究

目的:研究在移植受者血液标本中供者和受者源性DNA嵌合体存在是否可以作为预测移植器官免疫状态的一个标准.方法:126名获得男性肾脏的女性移植受者被纳入该项研究,通过RT-PCR方法检测这些女性受者血浆中Y染色体的特异基因序列SRY1,DYZ11st,DYZ12nd.结果:126名获男性肾脏的女性肾移植受者中,97名(77%)血浆中可检测到SRY1,DYZ11st,DYZ12nd序列.移植肾功能维持正常的平均持续时间,在微嵌合体阳性组及微嵌合体阴性组分别为8.7年和5.4年;肾移植术后急性排斥反应发生率在微嵌合体阳性组和阴性组分别为10%和28%;微嵌合体阳性病人血清肌酐水平明显低于微嵌合体阴性病人.结论:肾移植术后某些受者血浆中存在DNA微嵌合体,通过使用定量RT-PCR检测血浆中DNA微嵌合体可能成为衡量移植肾耐受状态的一个预测指标.     

Marked genetic similarities between hepatitis B virus-positive and hepatitis C virus-positive hepatocellular carcinomas

Hepatocellular carcinoma (HCC) is one of the most common neoplasms worldwide. Well-established risk factors include infections with two very different viruses: the DNA virus causing hepatitis B (HBV) and the RNA virus inducing hepatitis C (HCV). In order to determine whether genetic differences exist between HBV- and HCV-induced HCC, 41 HCC samples of known vival status were examined by comparative genomic hybridization (CGH). The analysis revealed frequent deletions of 1p (24%), 4q (39%), 6q (41%), 8p (44%), 9p (24%), 11q (24%), 12q (22%), and 13q (39%), as well as common gains of 1q (46%), 6p+ (20%), 8q+ (41%), 11q (27%), and 17q+ (37%). There was no significant difference in the number and type of chromosomal imbalances between 25 HCV- and 16 HBV-infected tumours. This is consistent with models suggesting that HBV and HCV cause cancer through non-specific inflammatory and regenerative processes, rather than through virus-specific interactions with defined target genes. Chromosomal imbalances were also unrelated to the grade and stage of HCC. This may suggest that most gross genomic alterations occur early during HCC development and that further progression of these tumours may be associated with other types of genetic changes, not detectable by CGH. In summary, these data show that characteristic gross genomic changes occur in HCC, but these alterations at present do not appear to have diagnostic or prognostic applications.     

Oval cells in hepatitis B virus-positive and hepatitis C virus-positive liver cirrhosis: histological and ultrastructural study

AIMS: It is still not clear whether oval cells demonstrate diverse morphology, immunophenotype or quantity in different human liver diseases. The aim of this study was to investigate these differences in hepatitis B virus (HBV)-positive and hepatitis C virus (HCV)-positive human liver cirrhosis (HLC). METHODS AND RESULTS: Thirty-eight cases of HBV+ HLC and 32 cases of HCV+ HLC were investigated by light microscopy and immunohistochemistry for Hepatocyte, CK19, stem cell factor (SCF) and CD34. Five cases were also examined by transmission electron microscopy. Oval cells of similar morphology could be found in proliferating bile ductules in both groups. These cells coexpressed CK19 and Hepatocyte, but did not express SCF or CD34. Some of these cells exhibited a trend towards differentiation. There was no difference in the amount of oval cells between the two groups. The oval cell number was found to increase significantly with the progression of inflammation. A similar stem-like cell was not seen in the normal liver. CONCLUSIONS: There are bipotential oval cells in both HBV+ and HCV+ HLC. The lack of difference in oval cells between the two groups suggests that they might play a similar biological role in the histogenesis of different liver diseases.     

亲属活体肾移植后供者安全性评价

背景：随访研究表明,肾移植对供肾者的安全影响较正常人群无统计学差异,甚至有更高的生活质量。目的：评价亲属活体肾移植对供者的安全性影响。方法：通过门诊定期随访、配合电话随访以及定期举办肾友会的方式对94例亲属活体肾移植后供者随访1-10年,比较肾移植供者供肾前后血清肌酐、血尿和尿蛋白以及血压和血脂的变化情况。结果与结论：供者供肾后出院时血清肌酐较供肾前明显升高(P < 0.01),但仍在正常范围内,且保持在稳定水平,最近一次随访时血清肌酐与出院时差异无显著性意义(P > 0.05)。供者供肾后镜下血尿3例(3.2%)、蛋白尿2例(2.1%),经休息后可好转;高血压6例(6.4%);高脂血症6例(6.4%);无一例供者死亡。说明对于健康供者而言,供肾是安全可行的,供肾前全面评估和供肾后长期随访对保障供者的安全有十分重要的意义。     

Unexpected distribution of hepatitis C virus genotypes in patients on hemodialysis and kidney transplant recipients

The distribution of hepatitis C virus (HCV) genotypes in patients on hemodialysis and in kidney transplant recipients was compared with that observed in a control group composed of HCV-infected individuals from the general population. A total of 340 patients were included in the study: 46 with end-stage renal disease on regular hemodialysis treatment, 22 kidney transplant recipients and 272 controls matched for sex and age at a 4:1 ratio (controls to patient). HCV genotype was determined by sequencing of the 5' untranslated region of the HCV genome. No difference was observed in the distribution of HCV genotypes in hemodialysis patients and renal transplant patients (P = 0.47). However, when each of these groups was compared with the control group, a significant difference was detected in the genotype distribution (P < 0.001). In hemodialysis and renal transplant patients the most prevalent subtype was 1a, followed by 1b, 3, and other less prevalent genotypes (2, 4, and 5), whereas in the control group the most prevalent subtype was 1b, followed by 3, 1a, and others. That observation may reflect differences in the epidemiology of HCV infection, viral characteristics and host factors in renal patients in comparison to the control group.     

Recurrent hepatitis C after liver transplantation

Cirrhosis due to hepatitis C is now the commonest indication for liver transplantation in Western Europe and in the United States. Graft reinfection is almost universal. The natural history of recurrent hepatitis C ranges from minimal damage to cirrhosis in a few months or years. Different virus and host immune factors are involved in the pathogenesis of hepatitis and are determinants of the outcome. The association between immunosuppression and severity of HCV recurrence is conflicting and remains to be evaluated fully. The treatment of recurrent HCV disease with IFN or ribavirin, as monotherapy, is ineffective. Preliminary results from combination therapy, however, are encouraging. Currently, a reasonable approach would be to treat patients with histological and clinical disease progression. New approaches for the prophylaxis of recurrent hepatitis C are under evaluation but whether this treatment will influence the severity of liver disease or the outcome of recurrence is still unknown.     

Association between human leukocyte antigen class I and II alleles and hepatitis C virus infection in high-risk hemodialysis patients awaiting kidney transplantation

Recent evidences have shown that several host genetic factors influence susceptibility or protection to hepatitis C virus (HCV) infection. There are controversial data regarding the associations of human leukocyte antigens (HLA) and the clearance or progression of HCV. The aim of this study was to investigate whether particular HLA molecules were associated with HCV infection in recipients awaiting kidney transplantation considered at high-risk to infection due to protracted hemodialysis treatment. To this purpose, 301 kidney recipients with HCV infection and 1103 uninfected recipients were examined for HLA class I and II molecules. In our case-control study, HLA-A^*26 is positively associated with HCV infection while HLA-A^*29, -B^*40 and -DRB1^*01 are negatively associated with HCV infection. Multiple logistic regression analysis demonstrated that age (OR = 1.02; 95% CI = 1.01–1.04; p < 0.00), HLA-A^*26, -A^*29, -B^*40 and -DRB1^*01 [(OR = 1.54; 95% CI = 1.03–2.30; p = 0.03); (OR = 0.50; 95% CI = 0.26–0.99; p = 0.05); (OR = 0.42; 95% CI = 0.23-0, 7; p = 0.01); (OR = 0.62; 95% CI = 0.41-0, 94; p = 0.03); respectively] are independent predictors of HCV infection. Our results suggest that particular HLA molecules, as host genetic factors, may have a relationship with susceptibility or protection to HCV infection also in recipients awaiting kidney transplantation.     

合并心力衰竭尿毒症肾移植患者采用腰-硬联合麻醉的安全性

背景：尿毒症合并心力衰竭不是肾移植的禁忌证,但此时麻醉管理比较困难。 目的：观察腰-硬联合麻醉用于尿毒症合并急性左心衰竭肾移植时的安全性。 方法：采用腰-硬联合阻滞麻醉为16例合并心力衰竭的患者实施同种异体的尸体肾移植,观察患者腰麻前、腰麻后10 min、移植肾再灌注前、移植肾再灌注后、移植结束时5个时点的收缩压、舒张压、心率和脉搏血氧饱和度变化。 结果与结论：与麻醉前相比,腰麻后10 min患者收缩压、舒张压、心率显著降低(P < 0.05),心力衰竭症状明显减轻。移植开始后到移植肾再灌注期间,血流动力学稳定,心衰症状基本缓解。与腰麻后10 min、移植肾再灌注前相比,移植肾再灌注后血压明显降低、心率轻度增快(P < 0.05)。移植肾再灌注后到移植结束,血流动力学较为稳定,患者心力衰竭症状完全缓解。16例患者均平稳渡过麻醉期。提示腰-硬联合麻醉用于急性左心衰竭患者的肾移植,把握好腰麻药的给药量和注入速度,不仅术中麻醉效果好、肌松满意,而且能降低心脏后负荷,改善心肺功能,保持血流动力学稳定,不影响移植肾的血液灌注。     

肾移植术后肺部感染23例临床分析

目的分析肾移植术后肺部感染的临床特点和诊治措施。方法对23例肾移植术后并发肺部感染患者的临床资料进行回顾性分析。结果23例患者中巨细胞病毒感染9例,其中合并细菌感染2例。细菌感染7例,其中复合细菌感染1例,细菌合并真菌感染2例;肺部真菌感染4例。发生细菌败血症1例,真菌败血症1例。另3例未检出病原体。经综合治疗本组中22例治愈,1例死亡,为细菌合并真菌感染的重症肺部感染者,死亡原因为急性呼吸窘迫综合征。结论肾移植术后合并肺部感染病情复杂,死亡率较高;可靠的病原学诊断、及时而有效的综合治疗可提高其治愈率。