人巨细胞病毒感染对肾移植受者血清白细胞介素—6水平的影响

应用ＰＣＲ检测ＨＣＭＶ－ＤＮＡ，ＥＬＩＳＡ检测ＨＣＭＶ－ＩｇＭ，ＩｇＧ，诊断肾移植受者ＨＣＭＶ感染，６５例受者中ＨＣＭＶ感染者３９例，非感染者２６例。应用ＭＴＴ法检测受者血清ＩＬ－６生物活性，阐明了ＨＣＭＶ感染对肾移植受者血清ＩＬ－６水平的影响。结果表明：感染与非感染组间血清ＩＬ－６水平差异无显著性；６例原发性感染者血清ＩＬ－６水平随感染时间延长呈增高及降低双相改变，表明慢性迁延性感染者血清ＩＬ－     

人巨细胞病毒感染对肾移植受者血清白细胞介素－6水平的影响

应用ＰＣＲ检测ＨＣＭＶ－ＤＮＡ，ＥＬＩＳＡ检测ＨＣＭＶ－ＩｇＭ、ＩｇＧ，诊断肾移植受者ＨＣＭＶ感染，６５例受者中ＨＣＭＶ感染者３９例，非感染者２６例。应用ＭＴＴ法检测受者血清ＩＬ－６生物活性，阐明了ＨＣＭＶ感染对肾移植受者血清ＩＬ－６水平的影响。结果表明：感染与非感染组间血清ＩＬ－６水平差异无显著性（Ｐ＞０．０５）；６例原发性感染者血清ＩＬ－６水平随感染时间延长呈增高及降低双相改变，表明慢性迁延性感染者血清ＩＬ－６水平降低。临床工作中监测ＨＣＭＶ感染的肾移植受者血清ＩＬ－６水平变化具有重要意义。     

肾移植受者体内细胞因子及其受体的水平及意义

检测了７２例肾移植患者血中可溶性白细胞介素２受体（ＳＩＬ－２Ｒ）、肿瘤坏死因子（ＴＮＦ）及白细胞介素６（ＩＬ－６）的水平。结果发现，正常健康对照组ＳＩＬ－２Ｒ为１２５±５４ｋＵ／Ｌ，术后肾功能平稳组为２５６±９３ｋＵ／Ｌ，环孢素Ａ中毒组为３３８±７３ｋＵ／Ｌ，而ＴＮＦ在这几组中均测不出，ＩＬ－６均小于５ｋＵ／Ｌ。肾移植术后ＳＩＬ－２Ｒ迅速下降，与血肌酐有明显的一致性，ＩＬ－６水平升高，第２天达高峰（１８．２５±２．３６ｋＵ／Ｌ），以后逐渐下降，１０天后降至５ｋＵ／Ｌ。发生急性排斥反应组ＳＩＬ－２Ｒ为１０７７±４４８ｋＵ／Ｌ，升高较血肌酐提早２．２天，敏感性达９４．４％，特异性达９１．７％；ＩＬ－６为５９．９±３５．２７ｋＵ／Ｌ，并较临床症状出现平均提早１．２天；ＴＮＦ为３３．６７±１３．７μｇ／Ｌ，检出率为６７％。感染组的ＳＩＬ－２Ｒ、ＩＬ－６、ＴＮＦ分别为１６２０±３９７ｋＵ／Ｌ、７９．７５±６１ｋＵ／Ｌ及１２７．５±８３．８μｇ／Ｌ。结果表明，ＳＩＬ－２Ｒ、ＴＮＦ、ＩＬ－６可作为监测肾移植排斥反应的指标。     

肾移植术后高脂血症

随着器官移植技术的进步,肾移植术后急性并发症发生大大减少,一些慢性并发症如心血管疾病、高脂血症等成为影响移植肾存活的主要因素。肾移植术后高脂血症是造成动脉粥样硬化的主要原因,可引起心血管系统并发症,严重可致患者死亡。研究亦表明高脂血症是移植肾慢性肾病(CAN)的直接原因,影响移植物的长期存活。因此,加强对肾移植术后高脂血症的预防、诊断及治疗非常重要。一、一般特征终末期肾病患者多伴有血脂异常,主要类型是高甘油三酯血症,有40%~50%的患者存在此类脂代谢异常。其中以腹透患者情况为重,因腹透液中葡萄糖被吸收或腹膜转运…     

肾移植受者血清IgE和SIL—2R的监测价值

本文通过肾移植受者血清IgE和SIL－2R水平的动态监测，观察术后排斥反应、并发感染、环孢素A（CsA）肾中毒时的浓度变化。发现它们是了解移植肾功能状态的快速、简便、无创伤性的理想指标。肾移植患者53例，男36例，女17例，年龄22～58岁，平均36．2岁。供受者ABO同血型，淋巴毒性试验平均5．3％，术后常规应用三联免疫抑制剂，环孢素A、硫唑嘌呤、泼尼松。IgE和SIL－2R测定时间为：术前1天，术后第1周每天1次，策2周起每周2次，怀疑排斥、感染或CsA肾中毒时，立即取患者血清测定。测定结果见附表。从表中可见，术前尿毒症组IgE与…     

肾移植术后高脂血症的防治

随着多种高效、低毒免疫抑制剂的开发和应用以及移植技术的不断进步，近年来肾移植受者的短期存活率得到了显著提高，术后1年人、肾存活率均已经超过90％。相比于维持透析，肾移植治疗终末期肾病虽然有明显的生存优势，但是受者的长期存活率并不令人满意，其中心血管并发症是影响受者长期存活的主要因素之一。在欧美国家，近40％的肾移植受者死于心血管并发症。虽然我国肾移植受者心血管并发症的发生率低于欧美国家，但近年来也呈现明显的上升趋势。     

肾移植术后血清IL—6水平的动态监测及临床意义

目的：观察肾移植术后发生急性排斥反应、感染、CsA中毒时血清IL-6的变化,以探讨IL-6在急性排斥反应的早期诊断、鉴别诊断中的意义。方法：采用双抗体夹心酶联免疫吸附法,对106例肾移植患者血清IL-6活性水平于肾移植手术前后进行动态监测。结果：肾移植术前,IL-6与对照组比较差别无显著性意义。术后第1天明显升高,2周左右基本降至术前水平。发生急性排斥反应前1-3天。血清IL-6即有升高,峰值出现在抗排斥反应治疗的当天,经甲基本降至术前水平,发生急性排斥反应前1-3天,血清IL-6即有升高,峰值出现在抗排斥反应治疗的当天,经甲基泼尼松尼（MP）冲击有效后迅速下降,治疗无效者,血清IL-6持续在高水平,并发感染时,IL-6也显著升高,与急性排斥反应组相比差别无显著性意义;而CsA中毒时,IL-6变化不明显。结论：动态监测IL-6可以作为急性排斥反应的早期诊断,鉴别诊断的免疫生物学指标。     

监测肾移植术后IL—2和sIL—2R的变化及其意义

对７２例肾移植患者术后血清ＩＬ－２和ｓＩＬ－２Ｒ进行检测，分析移植术后ＩＬ－２和ｓＩＬ－２Ｒ的变化规律，发现在急性排斥和继发感染时，患者血中ＩＬ－２和ｓＩＬ－２Ｒ含量均明显升高。认为监测肾移植术后ＩＬ－２和ｓＩＬ－２Ｒ的变化有助于了解免疫抑制水平和体内免疫系统的功能状态，并可早期诊断急性排斥和继发感染。     

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.     

肾移植后血管并发症的诊治体会

目的探讨。肾移植术后血管并发症的特点和诊治方法。方法回顾34例术后并发血管疾病的。肾移植患者临床资料，对其发病特点和诊治方法进行分析总结。结果34例患者中，并发移植肾动脉梗阻13例，移植肾动脉出血8例，动脉吻合口破裂7例，移植肾静脉梗阻4例，髂外动脉瘤和髂外静脉栓塞各1例。21例经彩色多普勒血流显像（CDFI）作出诊断，其中10例进一步行磁共振血管成像（MRA）明确诊断。5例移植。肾动脉狭窄患者中，3例放置血管内支架扩张后肾功能恢复良好，分别随访8、10、14个月，血肌酐维持在115～135μmol／L；1例将与髂内动脉端端吻合的移植。肾动脉改为与髂外动脉端侧吻合，术后至今1个月，血肌酐降至正常水平；1例MRA显示不完全狭窄，给予保守治疗，至今观察21d，血肌酐持续降低。3例静脉梗阻患者经手术解除梗阻，其中1例死于心力衰竭，另2例随访13、36个月，肾功能恢复良好。1例髂外静脉栓塞患者术后死于移植肾破裂。其余患者均切除移植肾。结论。肾移植术后的血管并发症进展迅速，应根据具体情况及时采取相应治疗手段，处理不及时往往导致移植肾功能丧失，因此早期诊断非常重要，CDFI可作为首选筛查手段。     

Reduction of Foxp3-expressing regulatory T cell infiltrates during the progression of renal allograft rejection in a mouse model

BACKGROUND: Regulatory T (Treg) cells are the immune suppressors in the maintenance of immune homeostasis and tolerance to self and non-self antigens, and may have therapeutic potential in the treatment of transplant rejection in patients. However, Treg cell development and action are poorly understood in transplantation. In this study, the association of CD4(+)Foxp3(+) infiltrates within renal allograft tissue with graft survival was investigated in a mouse model. METHODS: Kidney donors from C57BL/6J mice (H-2(b)) were transplanted to bilaterally nephrectomized Balb/c recipient mice (H-2(d)). Treg cells were examined with FACS and immunohistochemical staining. RESULTS: Here we showed that without any immunosuppressive regimen, kidney allografts were mostly rejected from 20 to 60 days after transplantation. During the progression of allograft rejection Foxp3(+) Treg phenotype infiltrates were significantly diminished, while intragraft expression of TGF-beta1, IL-6, IL-17 and IL-23 was up-regulated. The regulatory function of CD4(+)CD25(+) infiltrates was confirmed by their suppressive activity in mixed lymphocyte reaction. Further in vitro studies indicated that primary renal tubular epithelial cell (TEC) cultures produced high levels of IL-6 in response to allogeneic lymphocyte or IL-17 stimulation, and neutralization of IL-6 increased CD4(+)CD25(+)Foxp3(+) cells in co-cultures with TEC. CONCLUSION: Diminution of Foxp3(+) Treg infiltrates associates with renal allograft rejection, and neutralization of IL-6 activity enhances Foxp3(+) Treg cell differentiation. Our findings suggest that increase in intragraft IL-6 may down-regulate infiltrating Foxp3(+) Treg cells.     

Single-center experience with renal transplantation in patients with Wegener's granulomatosis

Between 1980 and 1995, 13 patients with end-stage renal disease due to Wegener's granulomatosis received 14 renal transplants (10 cadaveric, 4 living related). The mean follow-up in the 13 successfully transplanted patients was 50 months (4–107 months). One patient had primary nonfunction and received another graft 4 months later. Three episodes of acute rejection occurred in two patients, and one of these patients lost her graft due to severe vascular rejection 4 months after transplantation. Two patients died with well-functioning grafts (one of metastatic cancer and one of sepsis). One patient presented with perisinusitis and had a mild recurrence of Wegener's disease. None of the patients developed recurrent disease in the transplanted organ. At the last follow-up, the mean creatinine ( ± SD) in the 12 patients with functioning grafts was 1.6 ± 0.6 mg/dl. We conclude that renal transplantation is an excellent treatment for renal failure due to Wegener's granulomatosis. Recurrence of the disease is uncommon in patients under immunosuppression, but careful monitoring is extremely important. Received: 1 July 1996 Received after revision: 6 September 1996 Accepted: 23 September 1996     

尿毒症患者肾移植前后血浆同型半胱氨酸浓度的变化及临床意义

目的:观察尿毒症患者肾移植前后血浆同型半胱氨酸(Hcy)浓度的变化,探讨其临床意义。方法:选择40例尿毒症患者,测定肾移植前及术后第3天、第10天、第15天、第30天、第90天血浆Hcy浓度,同时测定肾功能,比较肾移植前后血浆Hcy浓度的变化。结果:在肾移植前,40例患者中有38例血浆Hcy异常。肾移植后,血浆Hcy浓度随着肾功能的好转逐渐下降,在术后15天时基本降到正常水平;以后尽管肾功能稳定,血浆Hcy浓度逐渐上升,在30天时有26例患者血浆Hcy高于正常,90天时有30例患者血浆Hcy高于正常。结论:肾移植后血浆Hcy水平仍高于正常,可能是肾移植患者心血管发病率较高的原因。     

同种异体移植肾组织中B7蛋白的表达及其意义

目的观察同种异体移植肾组织中Ｂ７蛋白表达的特点，以期阐明其在急性细胞性排异中可能的致病作用。方法用ＰＡＰ免疫组织化学方法对急性细胞性排异（ＡＣＲ），无急性细胞性排异（Ｎ－ＡＣＲ）和正常对照肾组织中Ｂ７蛋白的表达进行观察，并结合肾间质中浸润淋巴细胞数和肾小管上ＨＬＡ－ＤＲ抗原的表达进行分析。结果ＡＣＲ组肾间质ＣＤ４＋，ＣＤ８＋和Ｂ细胞数较Ｎ－ＡＣＲ组和正常对照明显增高，与此相一致的是肾间质表达Ｂ７－１和Ｂ７－２的细胞也较Ｎ－ＡＣＲ组增高，但Ｂ７－２增加更明显。ＡＣＲ组肾小管上皮细胞ＨＬＡ－ＤＲ及Ｂ７－１的表达较Ｎ－ＡＣＲ组明显增高。结论肾小管上皮细胞有可能通过ＨＬＡ－ＤＲ和Ｂ７－１表达的上调作为抗原提呈细胞主动参与上述免疫反应的发生。     

肾移植预后影响因素的COX模型分析

目的探讨影响肾移植预后的主要因素.方法采用寿命表法和COX回归模型对249例肾移植患者以性别、年龄、治疗方案选择、并发症等因素作为分析因子,计算生存率,分析预后影响因素.结果249例肾移植患者术后存活满1、2、3年的生存概率分别为72.6%、56.0%、40.8%,4年和5年生存概率均为22.5%,中位生存时间34.9个月.随着治疗时间延长,霉酚酸酯方案治疗者生存状况优于硫唑嘌呤方案者,中位生存期分别为38.9个月和30.6个月;COX回归模型提示影响肾移植预后主要因素依次为治疗方案、移植后随访时间、药物依从性、急性排斥反应、性别及住院时间（P＜0.05）.结论应用寿命表和COX回归模型分析评价肾移植患者预后生存状况以及影响因素是一种较为理想的方法.     

Long-term follow up of renal function and histology after renal allograft transplantation in early childhood

Abstract Survival rates, renal function, and histopathology were evaluated in 49 prospectively followed patients transplanted under 5 years of age at our center. Most patients (84%) suffered from congenital nephrosis of the Finnish type. Triple immunosuppression with cyclosporin administered in three daily doses to pre-school children was used. Patient survival 7 years after transplantation was 98 % and graft survival 88 %. All graft losses were due to post-transplantation nephrosis. The proportion of pathological findings in the follow-up biopsies did not change substantially with time. Five years after transplantation, 47 % showed a normal histology and after 7 years this rose to 67 %. Mean glomerular filtration rate (GFR) was 68 and 55 ml min per 1.73 m² 5 years and 7 years, respectively, after transplantation. The decline in GFR with time was significant. We conclude that good long-term results can be achieved with individually tailored triple immunosuppression in the youngest age group, even with cadaveric donors.     

Venous thrombectomy in patients presenting with iliofemoral vein thrombosis after renal transplantation

In this study 14 patients presented with 15 episodes of iliofemoral vein thrombosis after renal transplantation. Seven patients (group 1) had viable renal grafts and were treated with conventional anticoagulation. Eight patients (group 2) had non-viable renal grafts and were subjected to graft nephrectomy and simultaneous venous thrombectomy without anticoagulation. The patients in group 2 had rapid resolution of the signs and symptoms of the iliofemoral vein thrombosis, and noninvasive vascular investigation at follow-up revealed competent and patent deep veins in all patients. In contrast, only 50% of the patients in group 1 had normal venous studies at follow-up. We recommend that renal transplant recipients who develop iliofemoral vein thrombosis and nonviable allograft postoperatively should be subjected to venous thrombectomy at the time of graft nephrectomy.     

肾移植术后发生高尿酸血症的机制

目的：探讨肾移植术后发生高尿酸血症的机制及防治策略。方法：分析480例肾移植术后患者的临床资料。结果：肾移植术后移植肾功能正常而血尿酸增高者43例(9％)，其中痛风7例，移植肾肾盂或输尿管结石3例。随访1～5年，1例痛风患者血尿酸及症状控制不理想，余血尿酸均控制在正常水平，未见并发症的发生。结论：高尿酸血症是肾移植术后较常见的问题，发生原因较多，但主要与环孢素A的作用有关；长期降尿酸及碱化尿液治疗安全、有效。     

病毒性肝炎患者肾移植后的临床观察

目的：探讨病毒性肝炎患者肾移植后的近期存活率。方法：对60例乙型肝炎病毒表面抗原（HBsAg)及丙型肝炎病毒（HCV）阳性患者与60例肝功能正常患者肾移植后1,3,5年的存活率进行比较。结果：60例HB Ag及HCV阳性者的肝肾功能,并发症,存活率及死亡率与肝功能正常组的差异无显著性。结论：HBsAg及HCV阳性患者可以接受肾移植,近期存活率与肝功能正常者相仿。