硫唑嘌呤或骁悉治疗的肾移植患者术后早期并发症比较

目的:比较硫唑嘌呤(azathioprine,Aza)或霉酚酸酯(mycophenolate mofetil,MMF)联合环孢素 激素两种免疫抑制方案的肾移植患者,在术后并发症方面的差异,探讨较理想的免疫抑制方案。方法:收集两组肾移植患者249例:Aza组(即应用Aza CsA 激素)、MMF组(MMF CsA 激素),统计两组患者在术后1年内各种并发症(包括排斥反应、各种感染、肝损害、白细胞减少等)的发生。结果:Aza组与MMF组术后1年急性排斥反应的发生率差异显著;两组总的感染率、肺部感染率相近,但发生急性呼吸窘迫综合征(ARDS)及肺部感染病死率后者明显高于前者。在肝损害、白细胞减少、糖尿病等方面,两组也无统计学差异。结论:MMF组在减少急性排异方面优于Aza组,但增加重症肺部感染机会,肺部感染的病死率升高,且费用贵,故临床上应根据具体情况选择。     

不同免疫抑制剂所致肾移植受者血脂水平变化的比较

目的 探讨不同免疫抑制剂对肾移植患者术后血脂变化的影响. 方法 肾移植术后患者283例,分别选择他克莫司(FK506),环孢素(CsA)和西罗莫司(SRL)免疫抑制剂治疗方案,比较不同免疫抑制剂患者移植前及术后不同时段血清总胆固醇(TC)和三酰甘油(TG)浓度差异. 结果 FK506组93例患者服药前与服药后96周血清TC和TG浓度分别为(4.9±1.1)、(1.45=0.8)mmol/L与(4.9±1.1)、(1.4±1.0)mmol/L,差异无统计学意义(P>0.05).CsA组106例患者分别为(4.8±1.0)、(1.6±0.8)mmol/L与(6.6±1.7)、(3.2±1.0)mmol/L,差异有统计学意义(P<0.01).CsA组和SRL组患者血清TC和TG浓度一般于服药后12～24周时开始升高.51例服用12周CsA后改为FK506,患者改药前及改药后72周血清TC和TG浓度分别为(6.7±1.1)、(2.8±1.0)mmol/L与(4.7±1.7)、(1.5±1.1)mmol/L,差异有统计学意义(P<0.01). 结论 脂质紊乱是肾移植患者非免疫因素引起慢性排斥反应和慢性移植物失功的重要原因,CsA和SRL是引起肾移植患者术后血脂增高的主要因素之一.对于高脂血症肾移植患者免疫抑制剂应用可优先考虑FK506,避免SRL、CsA合用而加剧血脂升高.     

免疫抑制剂对肾移植受者术后并发恶性肿瘤的影响

目的观察肾移植术后恶性肿瘤的发生情况及免疫抑制剂对其发生的影响。方法回顾性分析1996年1月至2006年12月在济南军区总医院进行同种异体肾移植的852例受者中39例发生恶性肿瘤患者的临床资料,将其分为硫唑嘌呤（AZA）组（n=12）和吗替麦考酚酯（MMF）组（n=27）,应用Kaplan-Meier法估计并绘制两组生存曲线,用log-rank法比较两组生存率,分析免疫抑制剂对并发恶性肿瘤患者生存的影响。结果 852例肾移植受者术后恶性肿瘤总发生率为4.6%（39/852）,其中泌尿系统肿瘤占74.4%（29/39）、消化系统肿瘤占15.4%（6/39）、肺癌占7.7%（3/39）、皮肤癌占2.5%（1/39）。3年无病生存率AZA组为83.1%,MMF组为81.1%;平均生存时间AZA组为（64±8）个月,MMF组为（53±4）个月;两组3年无病生存率及平均生存时间比较差异均无统计学意义（P=0.16,P=0.61）。使用两种不同免疫抑制剂的肾移植术后并发恶性肿瘤患者的病死率差异无统计学意义（χ2=0.075,P〉0.05）。结论肾移植术后并发恶性肿瘤仍以泌尿系统肿瘤为主。AZA与MMF两种免疫抑制剂对肾移植术后并发恶性肿瘤的影响没有明显区别。     

血管紧张素转化酶抑制剂与硫唑嘌呤合用导致肾移植受者贫血

为了解血管紧张素转化酶（ACE）抑制剂与硫唑嘌吟联合使用对肾移植受者造血功能的影响，对168例肾移植进行回顾性分析。发现当上述两种药物同时应用时，绝大多数患者都会发生不同程度的贫血，而两种药物若单独使用，则贫血很少发生。另外，这两种药物同时应用停止后，贫血可逐渐得以纠正。认为ACE抑制剂与硫唑嘌呤合用是导致肾移植受者贫血的重要原因，临床上应避免二者同时使用。     

肾移植受者细胞因子基因多态性与术后发生感染的关系

目的　观察和分析肾移植受者术后感染的发生与细胞因子和细胞因子受体基因多态性的关系。方法　根据肾移植术后6个月内是否发生感染,将 126 例受者分为感染组和未感染组。比较两组受者发生感染的主要影响因素;13种细胞因子及受体 22 个位点的基因型分布情况; IL 6、TNF α、TGF β、IL 10高、中、低表达型的分布情况。根据受者发生和未发生急性排斥,分别比较阳性基因多态性的各种基因型在感染和未感染组中的分布情况。结果　感染组急性排斥发生率为55.4%,而未感染组则为14.3%,差异有统计学意义(P<0.05);IL 1α 889C/C、IL 1β 511C/C、IL 1β 3962C/T和T/T基因型频率及TGF β1高表达型频率明显高于未感染组(P<0.05)。未发生急性排斥的感染者中,IL 1β 511C/C基因型频率高于未感染者(P<0.05);发生急性排斥的感染者中 TGF β1(密10 密25)CG/TG、TGF β1(密10 密 25)高表达型的频率明显高于未感染者(P<0.05)。结论　肾移植术后发生急性排斥反应是感染发生的危险因素,受者的 IL 1α 889C/C、IL 1β 511C/C、TGF β1(密10 密25)高表达型(含CG/TG)与肾移植后感染的发生明显相关。     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

目的 观察氯沙坦对肾移植术后受者血红蛋白的影响,探讨其使用的安全性.方法 选取肾移植术后超过3个月,移植肾功能稳定,有高血压的受者66例.随机将受者分为两组.实验组:34例,加用氯沙坦或使用氯沙坦替换原有的降压药物;对照组32例,不使用氯沙坦.分组后对受者进行6个月的观察,分别测定0(基础值)、1、2、3及6个月共5个时间点受者的血红蛋白、血肌酐、肾小球滤过率(GFR)及血压等指标,并观察各指标的变化趋势.结果 实验组受者在使用氯沙坦1～2个月时的血红蛋白水平较基础值显著下降(P<0.05),2～6个月时趋于稳定;对照组受者的血红蛋白水平较基础值轻度上升(P>0.05).实验组中伴有高血红蛋白血症(PTE)的受者使用氯沙坦1～3个月时血红蛋白水平呈持续下降趋势(P<0.05),3～6个月时趋于稳定;对照组中伴有PTE的受者血红蛋白水平较基础值轻度下降(P>0.05).实验组中不伴有PTE的受者血红蛋白水平呈先下降后回升趋势;对照组中不伴有PTE的受者血红蛋白水平较基础值显著升高(P<0.05).实验组受者使用氯沙坦1个月时血肌酐水平呈升高趋势,2～6个月时逐渐恢复到基础值;对照组受者血肌酐水平无显著变化(P>0.05).实验组受者的GFR轻度下降后逐渐恢复到基础值;对照组受者的GFR呈逐渐上升趋势.实验组受者的血压呈明显下降趋势(P<0.05);对照组受者的血压较基础值无显著变化.结论 肾移植术后使用氯沙坦能降低受者的高血红蛋白水平,对PTE有一定的治疗和预防作用,并且不会影响受者的移植肾功能.对于肾移植术后有高血压且发生高血红蛋白血症的受者,使用氯沙坦是安全的.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

氯沙坦对肾移植术后受者血红蛋白的影响及其使用的安全性

Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.     

肾移植后不同免疫抑制方案的效果及不良反应的临床分析

目的 总结肾移植后使用不同免疫抑制方案的效果和不良反应,以提高人/肾的长期存活率.方法 对单中心3102例肾移植受者的临床资料进行回顾性分析,所采用的免疫抑制方案有环孢素A(CsA)+硫唑嘌呤(Aza)+泼尼松(Pred)、低剂量CsA+吗替麦考酚酯(MMF)+Pred、低剂量他克莫司(Tac)+MMF+Pred、低剂量CsA(或Tac)+西罗莫司(SRL)+Pred等方案,分析各方案的效果和不良反应.结果 低剂量CsA+MMF+Pred方案的人/肾1、5、10年存活率均高于CsA+Aza+Pred方案,而高血压、震颤、高尿酸、肝肾毒性、白细胞下降等的发生率显著低于CsA+Aza+Pred方案(P＜0.05),腹泻发生率显著高于CsA+Aza+Pred方案(P＜0.05).低剂量Tac+MMF+Pred方案的高血糖发生率显著高于低剂量CsA+MMF+Pred方案(P＜0.05),多毛症发生率显著低于低剂量CsA+MMF+Pred方案(P＜0.05);低剂量CsA(或Tac)+SRL+Pred方案的腹泻、高尿酸血症、肝肾毒性和多毛症等的发生率显著低于低剂量CsA(或Tac)+MMF+Pred方案(P＜0.05),但高血脂发生率显著高于后者(P＜0.05).以低剂量Tac为基础的方案者高血糖发生率显著应用低剂量CsA者.结论 低剂量CsA(或Tac)+MMF+Pred方案改善了肾移植受者和移植肾的存活,降低了不良反应发生率,尤以低剂量Tac+MMF+Pred方案为优;调整免疫抑制方案或剂量,改善饮食习惯,加强锻炼,优化降血压、降血脂、控制血糖的治疗措施对预防和控制不良反应尤为重要.

Abstract：

Objective To summarize the incidence and treatment experience of the effectiveness and adverse reactions of the different immunosuppressive protocols and to increase the long-term survival rate in kidney recipients. Methods Single-center retrospective analysis was performed on 3102 cases of kidney transplant recipients in effectiveness and adverse reactions of different immunosuppressive protocols. The immunosuppressive protocols were as follows: CsA + Aza + Pred,low dose CsA + MMF + Pred, low dose Tac + MMF + Pred, low dose CsA + SRL + Pred, and low dose Tac+ SRL+ Pred. Results The 1-, 5-, 10-year survival rate of patients/kidney in low dose CsA + MMF + Pred protocol was higher than that in CsA + Aza + Pred protocol. The incidence of adverse reactions, such as hypertension, hyperuricemia, kidney and liver toxicity, and leukopenia was significantly lower, but the incidence of diarrhea was significantly higher in CsA + MMF + Pred protocol than in CsA + Aza + Pred protocol (all P＜0. 01). The incidence of hyperglycemia was significantly higher (P＜0. 05), and that of hairy and gingival hyperplsia was significantly lower (P＜0. 05) in low dose Tac+ MMF+ Pred than in low dose CsA+ MMF+ Pred protocol. The incidence of hyperlipidemia in low dose CsA (or Tac)+ SRL + Pred was significantly higher than in CsA (or Tac)+ MMF+ Pred protocol (P＜0. 05). The incidence of hirsutism in low dose Tac + SRL + Pred was significantly lower than that in CsA + SRL + Pred protocol (P ＜ 0. 05). The incidence of hyperglycemia in low dose Tac + SRL + Pred was significantly higher than that in low dose CsA + SRL + Pred protocol. Conclusion The triple drug protocol with a low dose of CsA (or Tac)+ MMF+ Pred significantly improved the survival of renal transplant recipients and graft, and reduced the incidence of adverse reactions, especially Tae + MMF + Pred protocol. Adjustment of the immunosuppressant dosage and protocol, improvement of eating habits, exercise, reduction of blood pressure, reduction of blood lipid, and control of blood glucose were particularly important in preventing and controlling adverse reactions during kidney transplantation.     

Sporting activity following kidney transplantation

A postal questionnaire on sporting activity following renal transplantation revealed that most units encouraged participation in the majority of sports, but counselled against contact sports such as rugby football, boxing, and Asian martial arts.

Received May 27, 1997; received in revised form January 23, 1998; accepted January 25, 1998     

合并海洋性贫血的尿毒症患者肾移植的临床观察

目的探讨海洋性贫血对尿毒症患者肾移植效果的影响。方法为46例合并海洋性贫血的尿毒症患者施行。肾移植（海洋性贫血组），其中α海洋性贫血26例，β海洋性贫血20例，观察患者术后移植。肾功能恢复延迟（DGF）和排斥反应的发生率以及贫血的纠正情况，对于移植。肾功能恢复正常者，记录其。肾功能恢复正常的时间，并测定血肌酐值。以同期施行的131例。肾移植（均伴有程度不等的贫血，但非海洋性贫血）为对照。结果海洋性贫血组DGF的发生率为26．1％，对照组为23．7％，二者比较，差异无统计学意义。术后6个月，人、肾均存活，且未失访的患者，海洋性贫血组有39例，对照组有109例，6个月内，海洋性贫血组30．8％发生排斥反应，对照组32．1％发生排斥反应，两组比较，差异无统计学意义；海洋性贫血组的血肌酐值为（121±20）μmol／L，对照组为（128±33）μmol／L，两组比较，差异无统计学意义；海洋性贫血组79．5％的贫血得到纠正，对照组76．1％的贫血得到纠正，两组比较，差异无统计学意义。结论合并海洋性贫血的尿毒症患者可接受肾移植治疗，临床效果与不合并该病者相仿。     

多囊肾患者保留原肾的肾移植疗效分析

目的探讨多囊肾患者保留原肾的肾移植特点、手术方式及疗效。方法回顾性分析25例多囊肾患者肾移植前后原双侧肾脏体积变化以及移植肾功能恢复情况,以25例原发病为慢性肾小球肾炎肾移植患者为对照组。结果25例患者1年人/肾存活率分别为96.0%/92.0%,3年人/肾存活率为90.0%/90.0%;发生急性排斥反应7例(28.0%),移植肾失功2例(8.0%),死亡1例(4.0%);23例患者原肾脏逐渐缩小,左肾长、宽、厚由术前(20.72±4.40)cm、(14.11±2.45)cm、(9.01±1.05)cm缩小至(14.70±2.00)cm、(10.30±1.49)cm、(6.87±0.94)cm,右肾长、宽、厚由术前(20.11±2.64)cm、(15.10±2.14)cm、(9.18±0.96)cm缩小至(15.00±1.84)cm、(10.45±1.28)cm、(6.80±1.15)cm(P<0.05);23例患者移植肾功能稳定,血尿逐渐消失,术前血压(134.20±3.12)/(95.23±2.49)mm Hg(1 mm Hg=0.133 kPa),术后(128.58±2.59)/(92.34±3.40)mm Hg(P>0.05)。对照组1年人/肾存活率分别为100.0%/100.0%,3年人/肾存活率为96.0%/96.0%;发生急性排斥反应6例(24.0%),移植肾失功1例(4.0%),死亡1例(4.0%),与多囊肾组比较均P>0.05,差异无统计学意义。结论多囊肾患者肾移植,不切除原病变肾脏移植效果满意,移植后应严密观察患者移植肾功能、血尿和感染情况。     

去甲肾上腺素对肾移植术患者肾功能的影响

目的 探讨去甲肾上腺素对肾移植术患者肾功能的影响.方法 同种异体肾移植术患者32例,ASA分级Ⅲ或Ⅳ级,年龄22～64岁,随机分为多巴胺组(D组)和去甲肾上腺素组(N组),每组16例.麻醉诱导后D组静脉输注多巴胺1～10μg·kg-1·min-1,N组静脉输注去甲肾上腺素0.03～0.3μg·kg-1·min-1,持续至术毕,维持术中MAP波动幅度不超过基础水平的10%.分别于术毕及术后12 h时取中心静脉血样及尿样,测定血清半胱氨酸蛋白酶抑制因子C(Cystatin C)、β2-微球蛋白(β2-MG)及尿α1-微球蛋白(α1-MG)、β2-MG的浓度,并记录术中输液总量、肾血管开放至术毕时的尿量、术后12 h内的尿量及呋塞米的用量.结果 两组术中输液总量、尿量及呋塞米用量和各时点血清Cystatin C、β2-MG及尿α1-MG、β2-MG浓度比较差异无统计学意义(P＞0.05);与术毕时比较,术后12 h时两组患者血清Cystatin C、β2-MG及尿α1-MG、β2-MG浓度均降低(P＜0.05).结论 静脉输注去甲肾上腺素0.03～0.3μg·kg-1·min-1对移植肾功能无不良影响,可用于肾移植术患者.     

老年患者肾移植临床分析

目的　探讨 6 0岁以上老年患者肾移植的临床特点。方法　回顾性分析超过 6 0岁的81例肾移植患者的临床资料 ,并以同期小于 6 0岁的肾移植患者 432例作对照。结果　老年患者透析时间长 ,低蛋白血症严重 ,冠心病、糖尿病及心脏衰竭发病率高 ,与对照组比较 ,差异有显著性 (P <0 .0 5 ) ;老年组人 /肾 1、3年存活率分别为 90 .1% / 88.0 %、80 .6 % / 75 .0 % ,对照组分别为 93.7% /92 .6、81.1% / 76 .4% ,两组比较 ,差异无显著性 (P >0 .0 5 )。老年组术后肺部感染、肝功能损害、心脏衰竭、心绞痛及糖尿病等的发生率均高于对照组 (P <0 .0 5 )。结论　老年患者进行肾移植时 ,心血管并发症和感染是引起死亡的主要原因。术前应慎重选择、充分准备、严格配型 ,术后合理使用免疫抑制剂、积极处理并发症。     

嵌合体与同种异体肾移植免疫耐受相关性的研究

目的　探讨同种异体肾移植术后嵌合体表达情况与免疫耐受的相关性。　方法　采用3对引物 ,应用PCR和RT PCR方法 ,检测接受男性供体肾移植的女性受者外周血及尿沉渣Y染色体特异片段DNA和mRNA表达 ,进行嵌合体与免疫耐受相关性研究。　结果　 176例女性受者嵌合阳性 137例 ( 77.84 % ) ,阴性 39例 ( 2 2 .16 % )。阳性组平均存活时间 ( 8.9± 3.7)年 ,阴性组 ( 5 .2± 3.9)年 ,差异有显著性意义 (P <0 .0 5 ) ;阳性组发生排斥反应 15例 ( 10 .9% ) ,阴性组 11例 ( 2 8.2 % ) ,差异有显著性意义 (P <0 .0 5 )。　结论　肾移植术后受者体内嵌合状态与免疫耐受相关 ,微嵌合体可以作为器官移植免疫耐受监测的生物学参考指标     

肝肾联合移植治疗巨大多囊肾合并多囊肝并发肝肾功能衰竭

目的 总结巨大多囊肾合并多囊肝并发肝肾功能衰竭行肝肾联合移植的临床经验.方法 对8例巨大多囊肾合并多囊肝并发肝肾功能衰竭的患者进行肝肾联合移植,男性5例,女性3例;年龄41～67岁,平均52.8岁.先肝后肾采用经典非转流原位肝移植6例,先肾后肝并采用背驮式肝移植2例.术后对急性排斥反应、并发症、肝肾功能、人/肝/肾存活率等临床疗效进行长期随访.结果 随访28～65个月,8例患者均存活,肝肾功能正常.存活5年以上2例,4年以上2例,2年以上4例.围手术期并发胸腔积液2例,肺部金黄色葡萄球菌感染1例,均对症治疗后痊愈.截至随访终点,未发现移植物急性排斥反应.结论 巨大多囊肾合并多囊肝并发肝肾功能衰竭的患者,肝肾联合移植术是安全有效的治疗方法.     

肾移植后不同免疫抑制方案的效果及不良反应的临床分析

Objective To summarize the incidence and treatment experience of the effectiveness and adverse reactions of the different immunosuppressive protocols and to increase the long-term survival rate in kidney recipients. Methods Single-center retrospective analysis was performed on 3102 cases of kidney transplant recipients in effectiveness and adverse reactions of different immunosuppressive protocols. The immunosuppressive protocols were as follows: CsA + Aza + Pred,low dose CsA + MMF + Pred, low dose Tac + MMF + Pred, low dose CsA + SRL + Pred, and low dose Tac+ SRL+ Pred. Results The 1-, 5-, 10-year survival rate of patients/kidney in low dose CsA + MMF + Pred protocol was higher than that in CsA + Aza + Pred protocol. The incidence of adverse reactions, such as hypertension, hyperuricemia, kidney and liver toxicity, and leukopenia was significantly lower, but the incidence of diarrhea was significantly higher in CsA + MMF + Pred protocol than in CsA + Aza + Pred protocol (all P＜0. 01). The incidence of hyperglycemia was significantly higher (P＜0. 05), and that of hairy and gingival hyperplsia was significantly lower (P＜0. 05) in low dose Tac+ MMF+ Pred than in low dose CsA+ MMF+ Pred protocol. The incidence of hyperlipidemia in low dose CsA (or Tac)+ SRL + Pred was significantly higher than in CsA (or Tac)+ MMF+ Pred protocol (P＜0. 05). The incidence of hirsutism in low dose Tac + SRL + Pred was significantly lower than that in CsA + SRL + Pred protocol (P ＜ 0. 05). The incidence of hyperglycemia in low dose Tac + SRL + Pred was significantly higher than that in low dose CsA + SRL + Pred protocol. Conclusion The triple drug protocol with a low dose of CsA (or Tac)+ MMF+ Pred significantly improved the survival of renal transplant recipients and graft, and reduced the incidence of adverse reactions, especially Tae + MMF + Pred protocol. Adjustment of the immunosuppressant dosage and protocol, improvement of eating habits, exercise, reduction of blood pressure, reduction of blood lipid, and control of blood glucose were particularly important in preventing and controlling adverse reactions during kidney transplantation.     

肾移植后不同免疫抑制方案的效果及不良反应的临床分析

Objective To summarize the incidence and treatment experience of the effectiveness and adverse reactions of the different immunosuppressive protocols and to increase the long-term survival rate in kidney recipients. Methods Single-center retrospective analysis was performed on 3102 cases of kidney transplant recipients in effectiveness and adverse reactions of different immunosuppressive protocols. The immunosuppressive protocols were as follows: CsA + Aza + Pred,low dose CsA + MMF + Pred, low dose Tac + MMF + Pred, low dose CsA + SRL + Pred, and low dose Tac+ SRL+ Pred. Results The 1-, 5-, 10-year survival rate of patients/kidney in low dose CsA + MMF + Pred protocol was higher than that in CsA + Aza + Pred protocol. The incidence of adverse reactions, such as hypertension, hyperuricemia, kidney and liver toxicity, and leukopenia was significantly lower, but the incidence of diarrhea was significantly higher in CsA + MMF + Pred protocol than in CsA + Aza + Pred protocol (all P＜0. 01). The incidence of hyperglycemia was significantly higher (P＜0. 05), and that of hairy and gingival hyperplsia was significantly lower (P＜0. 05) in low dose Tac+ MMF+ Pred than in low dose CsA+ MMF+ Pred protocol. The incidence of hyperlipidemia in low dose CsA (or Tac)+ SRL + Pred was significantly higher than in CsA (or Tac)+ MMF+ Pred protocol (P＜0. 05). The incidence of hirsutism in low dose Tac + SRL + Pred was significantly lower than that in CsA + SRL + Pred protocol (P ＜ 0. 05). The incidence of hyperglycemia in low dose Tac + SRL + Pred was significantly higher than that in low dose CsA + SRL + Pred protocol. Conclusion The triple drug protocol with a low dose of CsA (or Tac)+ MMF+ Pred significantly improved the survival of renal transplant recipients and graft, and reduced the incidence of adverse reactions, especially Tae + MMF + Pred protocol. Adjustment of the immunosuppressant dosage and protocol, improvement of eating habits, exercise, reduction of blood pressure, reduction of blood lipid, and control of blood glucose were particularly important in preventing and controlling adverse reactions during kidney transplantation.