52例尿毒症患者肾移植前后脑电图、脑地形图的对比分析

对５２例尿毒症患者作肾移植前后脑电图（ＥＥＧ）、脑电地形图（ＢＥＡＭ）检查对比分析。术前ＥＥＧ异常率５５．８％，术后降至４０．４％，术前ＢＥＡＭ异常率６９．８％，术后降至５１．９％，且异常程度改善，但病程长，术前尿素氮＞３５．７ｍｍｏｌ／Ｌ者恢复慢，分析术前异常率高，其中一个原因亦与血透治疗有关。值得注意的是肾移植术后广泛应用环孢素，致术后ＥＥＧ、ＢＥＡＭ恢复与肾功能的恢复不呈正相关。提示应用ＥＥＧ、ＢＥＡＭ观察患者脑损害状况以及药物的神经毒性作用，可为临床提供简便有价值的参考。     

52例尿毒症患者移植前后脑电图,脑地形图的对比分析

对５２例尿毒症患者作肾移植前后脑电图，脑电地形图检查对比，主前ＥＥＧ异常率５５．８％，术后降至４０．４％，术前ＢＥＡＭ异常率６９．８％，术后降至５１．９％，且异常程度改善，但病程长，术前尿素氮＞３５．７ｍｍｏｌ／Ｌ者恢复慢，分析术前异常率高，其中一个原因亦与血透治疗有关。值得注意的是肾移植术后广泛应用环孢素，致术后ＥＥＧ、ＢＥＡＭ恢复与肾功能的恢复不呈正相关，提示应用ＥＥＧ，ＢＥＡＭ观察患者脑损害     

尿毒症频发心力衰竭患者肾移植15例

目的：探讨尿毒症频发心力衰竭(心衰)患者肾移植的可行性及安全性。方法：回顾性分析15例继发于尿毒症的顽固性心衰患者肾移植围手术期处理方法及临床效果。结果：14例患者安全度过围手术期，3个月后心脏缩小，心功能明显改善，移植肾功能正常；1例在术后第8天死于心肺功能衰竭。结论：顽固性心衰尿毒症患者可行肾移植，心衰并非肾移植的绝对禁忌证，只要受体选择合适，治疗及时得当，患者可安全度过肾移植围手术期。     

肾移植术前尿毒症患者合并症的手术治疗体会

目的 总结肾移植术前尿毒症合并症的手术治疗体会。以提高肾移植预后，方法 回顾性分析１９７８年至今尿毒症合并症３９例的手术指征。围手术期治疗以及肾移植预后情况，其中成人性多囊肾９例、药物不可控制性高血压２１例、脾功能亢进４例、胃溃疡５例。结果 ９例多囊肾切除术后１～６个月行肾移植术。随访肾功能正常；２１例高血压患者术后血压不同程度下降，术后６～１２个月行同种肾移植术，肾功能稳定；４例脾脾切除患者肾移     

严重尿毒症患者肾移植术的麻醉处理

我院共做肾移植手术千余例 ,有 8例尿毒症症状特别严重 ,1例患者接入手术室即出现心衰、肺水肿 ,另 1例硬膜外穿刺后给第一个局麻药剂量亦出现心衰、肺心肿 ,2例均放弃手术。 6例采用气管内插管 ,全凭静脉或静吸复合麻醉获得成功 ,现报告如下。临床资料6例均为男性 ,年龄 5 4～ 73岁 ,病史 3～ 9年 ,1例首次 ,2例第 2次 ,3例第 3次肾移植术。入院时均有明显尿少、全身乏力、头晕、恶心、浮肿、胸闷心悸、呼吸急促或端坐呼吸、颈静脉怒张、肝肿大。 5例反复出现心衰 ,经抢救好转 ,血压最高者 33 3/ 2 0 3ｋＰａ(2 80 / 15 2ｍｍＨｇ)。 6例…     

尿毒症和肾移植患者血清脂质及载脂蛋白水平测定

为了便于对尿毒症和肾移植患者并发心血管疾病趋势的分析，我们对６４例尿毒症患者和２０例肾移植患者分别用美国ＥｎｃｏｒｅⅡ型自动生化分析仪进行了７种血清脂质及载脂蛋白的测定。结果表明：尿毒症患者血清脂质及载脂蛋白含量与健康人相比，其中５种指标明显异常，已具备有发生冠心病的危险因素。而肾移植患者虽也有某些脂类指标异常，但Ａｐｏ－ＡＩ／Ａｐｏ－Ｂ１００比值这一重要指标正常，则发生冠心病的危险性较小。由此可     

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。     

高危肾病患者的肾移植(附5例报告)

目的 :探讨高危险性终末期肾病患者的肾移植。方法 :回顾性分析 5例高危险性肾病患者肾移植的临床资料 ,并结合文献复习讨论。结果 :1例肾移植术后 9年患右肾癌患者行右肾癌根治术 ,术后随访肿瘤未复发及转移 ,肾癌根治术后 2年 ,移植肾失功能 ,再次行肾移植 ;2例因尿路梗阻致尿毒症 ,经去除感染病灶等术前准备后再行肾移植 ;另 2例高龄 (>70岁 )尿毒症患者肾移植 ,1例失败 ,1例成功。结论 :高危险性肾病患者经充分术前准备可行肾移植并取得满意效果 ,但对高龄大于 70岁患者应慎重行肾移植术。     

尿毒症和肾移植患者精液参数的变化

目的:探讨尿毒症和肾移植患者精液参数的变化。方法:检测25例尿毒症患者(尿毒症组)和25 例肾移植术后患者(肾移植组)以及12例正常志愿者(正常对照组)的精液,并对其主要参数进行比较。结果:尿毒症组、肾移植组及正常对照组的精子活动力分别为(14.8±3.4)%、(50.7±4.8)% 和(63.8±3.6)% ;精子存活率分别为(27.2±4.8)% 、(71.9±6.0)%和(80.4±2.2)% ;精子密度分别为(22.2±3.8)×106/ml、(53.0±10.7)×106/ml和(67.6±14.9)×106/ml。肾移植组精液主要参数明显好于尿毒症组,差异有统计学意义(P<0.01),但与正常对照组比较,差异无统计学意义(P>0.05)。结论:肾移植可明显改善尿毒症患者的精液质量。     

影响尿毒症患者接受肾移植的因素初探

肾移植是治疗终末期肾脏病的有效方法，但在临床工作中发现相当多的尿毒症患对肾移植不甚了解或不认同，为此我们以问卷调查的形式对陕西省近10家医院的274名尿毒症患进行了调查，结果报道如下。     

Chickenpox in Adult Renal Transplant Recipients

Five of 610 adults developed chickenpox between 35 days and9.2 years after renal transplantation, and only one patientsurvived. All patients received prednisolone and azathioprineduring the incubation period. Corticosteroid therapy was continued,but azathioprine was stopped after diagnosis. Four patientswere treated with acyclovir, but three were given suboptimaldoses. The patient who survived had been taking the lowest doseof azathioprine and was given the recommended dose of acyclovir.All patients who died developed disseminated intravascular coagulation,and at postmortem examination were found to have had cerebralhaemorrhage. None of the patients treated with acyclovir hadevidence of active varicella-zoster virus infection at postmortem examination, but two had disseminated bacterial and fungalinfections. Chickenpox follows a severe and often fatal course in adultswith renal transplants. Prompt acyclovir therapy can be effective,provided an adequate dose is given. Attention should be directedtowards prevention by the identification and immunisation ofat risk patients prior to transplantation.     

血浆纤维结合蛋白在肾移植中的监测价值

对４１例透析治疗准备肾移植的患者作移植前、后的血浆纤维结合蛋白（ＰＦｎ）浓度的动态监测发现，移植术前ＰＦｎ低于正常；移植术后肾功能稳定组ＰＦｎ逐渐恢复正常；急性排斥反应组ＰＦｎ浓度下降，随排斥逆转，肾功能恢复，ＰＦｎ又上升到正常，而不可逆急性排斥时，ＰＦｎ始终波动在极低水平；术后并发感染时，感染初期ＰＦｂ一过性增高。结果表明，动态测定ＰＦｎ水平，对了解移植肾功能状态，预测排斥及并发感染的发生和演变     

Long-Term Outcomes of Immunosuppressed Renal Transplant Recipients with Malignancies

This study analyzes ten cases of malignancy in a cohort of 183 renal transplant recipients, examining surgical management, postoperative immunosuppressive therapy, and long-term outcome. One of these ten patients, who had malignant lymphoma of the jejunum, died of the neoplasm, but the other nine patients did not show any signs of tumor recurrence after removal. All of these nine patients, except for one who had transplant renal cell carcinoma (RCC), received the same dose of immunosuppressive agents after surgery for the malignant disease. Seven patients were still alive at the time of this report, six of whom had good transplant renal function. The findings of this study indicate that even if immunosuppressive agents predispose to the development of cancer, it is not necessary to reduce their dose after removal of the tumor. Received: April 17, 2000 / Accepted: November 20, 2000     

肾移植术后深部真菌感染10例报告

１９９１年１月－１９９３年１２月我所３３１例肾移植患者中发生深部真菌感染１０例，其中９例为念珠菌感染，１例为曲霉菌感染。经咪康唑或大扶康的正规治疗后，除１例发展为真菌性败血症死亡外，余９例感染治愈，但有３例移植肾因此丧失功能。我们认为肾移植术后应重视深部真菌感染问题，抗真菌药物以大扶康的首选。     

Adverse Effect of Cyclosporin on Plasma Cholesterol in Renal Transplant Recipients

A prospective study of changes in plasma lipids after renaltransplantation was performed in order to compare the effectsof cyclosporin and conventional immunosuppression. Twenty-eightpatients were studied, 18 of whom were allocated randomly toimmunosuppression with either cyclosporin alone (nine subjects)or azathioprine and prednisolone (nine subjects). A furtherten patients received cyclosporin and prednisolone. Total cholesterol,triglycerides and HDL, LDL and VLDL cholesterol subfractionswere measured before transplantation, 21 and 90 days after transplantation,and also, in 12 patients (six on cyclosporin and prednisolone,and six on azathioprine and prednisolone), 2 years after transplantation. Triglycerides were initially elevated, and decreased after transplantationin all three groups. Total cholesterol was unchanged in theazathioprine and prednisolone group, whereas it increased significantlyby 90 days in both the cyclosporin group and the cyclosporinand prednisolone group. This was due primarily to LDL cholesterol,which increased by 45% in the cyclosporin group and 28% in thecyclosponn and prednisolone group. Both total and LDL cholesterolremained elevated 2 years after transplantation in patientsreceiving cyclosporin and prednisolone, but were unchanged inthe azathioprine and prednisolone group. There was no relationshipbetween renal function and plasma lipid changes.     

Hyperparathyroidism, Hypertension and Loop Diuretic Medication in Renal Transplant Recipients

The associations between serum parathyroid hormone (PTH), bloodpressure and hypotensive medication were analysed in 282 renaltransplant recipients. Among patients with a normal concentrationof serum creatinine there was no correlation between serum PTHand blood pressure but in those receiving hypotensive medicationserum PTH was appropriately twofold greater than in those nottaking hypotensive medication. Analysis revealed that the dominantcontribution to this association was a specific associationwith loop diuretic therapy. When all patients were stratifiedaccording to creatinine clearance, serum PTH was always greaterin patients receiving loop diuretics but this difference wasparticularly striking in the patients with the poorest graftfunction. It is postulated that loop diuretics exacerbate thehyperparathyroidism which complicates renal disease.     

肾移植术后巨细胞病毒肺炎伴肾功能异常原因分析

目的：探讨肾移植术后早期巨细胞病毒（CMV）肺炎患者停用免疫抑制剂期间肾功能异常的原因。方法：2001年1月～2006年12月期间,肾移植术后CMV肺炎37例,在停用免疫抑制剂期间9例出现肾功能异常（肾功异常组）,28例肾功能保持正常（肾功正常组）。检测CMV肺炎发病后外周血CD4^＋细胞计数和血清肿瘤坏死因子-α（TNF-α）水平,选择同期术后3月无感染受者18例为对照（对照组）,对4例肾功能异常患者行肾穿刺活检。结果：9例患者均伴有急性呼吸窘迫综合征（ARDS）,需呼吸机辅助治疗。肾功能异常发生在停用免疫抑制剂后（8.9±3.3）d,停药的时间为（21.9±6.2）d,感染发病第7天两组外周血CD4^＋细胞计数明显较对照组低,血清TNF-α水平明显较对照组高,而肾功异常组TNF-α水平显著高于肾功正常组,组织病理学以肾小管上皮细胞变性、坏死、脱落为主要特征。结论：肾移植术后CMV肺炎患者机体免疫功能低下,停用免疫抑制剂是安全的,不会诱发急性排斥反应,炎症反应可能是移植肾功能损害的主要因素。     

460例次肾移植术后尿路并发症分析

本文报告我院460例次肾移植术后尿路并发症,共45例次,其中42例原发性(占9.13％),3例继发性,包括输尿管梗阻18例,输尿管或膀胱瘘26例,肾输尿管结石1例。除1例因行移植肾造瘘并发感染死亡外,余均经手术或非手术治愈。我们认为多数尿路并发症为外科技术所致,需要开放手术治疗。仔细的取肾、规范植肾手术操作和及早诊断是减少肾移植后尿路并发症发生的重要因素。     

Long-term Cardiac Outcomes in Renal Transplant Recipients Receiving Fluvastatin: The ALERT Extension Study

Renal transplant recipients (RTR) have an increased risk of premature cardiovascular disease. The ALERT study is the first trial to evaluate the effect of statin therapy on cardiac outcomes following renal transplantation. Patients initially randomized to fluvastatin or placebo in the 5-6 year ALERT study were offered open-label fluvastatin XL 80 mg/day in a 2-year extension to the original study. The primary endpoint was time to first major adverse cardiac event (MACE). Of 1787 patients who completed ALERT, 1652 (92%) were followed in the extension. Mean total follow-up was 6.7 years. Mean LDL-cholesterol was 98 mg/dL (2.5 mmol/L) at last follow-up compared to a pre-study level of 159 mg/dL (4.1 mmol/L). Patients randomized to fluvastatin had a reduced risk of MACE (hazards ratio [HR] 0.79, 95% CI 0.63-0.99, p = 0.036), and a 29% reduction in cardiac death or definite non-fatal MI (HR 0.71, 95% CI 0.55-0.93, p = 0.014). Total mortality and graft loss did not differ significantly between groups. Fluvastatin produces a safe and effective reduction in LDL-cholesterol associated with reduced risk of MACE in RTR. The lipid-lowering and cardiovascular benefits of fluvastatin are comparable to those of statins in other patient groups, and support use of fluvastatin in RTR.     

环孢素A血药浓度监测的临床意义

目的：探讨环孢素A(CsA)血药谷值浓度监测的临床意义。方法：对269例同种肾移植受者术后4081次CsA血药谷值浓度进行了分析。结果：随着移植肾存活时间的延长,CsA治疗浓度水平呈逐渐下降趋势。排斥反应发生时及排斥反应前两周内,CsA浓度不仅低下,而且有一持续约2周的显著下降过程,平均降幅达31％。术后一周内急性排斥反应的发生与CsA浓度关系不大。过高的CsA浓度则与肾中毒’反应有关。CsA治疗浓度与发生排斥反应时的浓度及肾中毒浓度均有一定程度的重叠。结论：认为术后CsA理想的治疗窗浓度应为：术后第1月内为300-450ng／ml,3月内为250～400ng／ml,半年内为200～350ng／ml,以后CsA浓度最好维持在150～250ng／ml。