超声引导移植肾穿刺活检的临床应用

目的 探讨超声引导移植肾穿刺活检对肾移植术后并发症诊断的临床应用价值及穿刺技术要点.方法 对24例患者的移植肾组织活检方法、病理结果与临床资料进行分析研究.结果 24例患者术后共行36次肾穿,取材失败1次,穿刺成功率为97.2%,取材质量良好率为83.3%.病理诊断急性排斥反应22次、急性肾小管坏死9次、慢性排斥反应2次、其它肾组织病变17次.临床诊断与病理诊断完全符合者6次,约占17%;部分符合者21次,约占60%;完全不符合者8次,约占23%.结论 超声引导移植肾穿刺活检对临床正确诊断术后并发症及选择治疗方案有重要价值.灵活选择移植肾穿刺路径和注意穿刺时机可更有效地避免穿刺并发症.     

超声引导下经皮移植肾穿刺活检的临床应用

目的探讨影响超声引导下经皮移植肾穿刺活检成功率的有关因素,提高穿刺活检的成功率。方法在超声引导下采用侧槽切割式自动活检枪行经皮移植肾穿刺活检术,分析取材长度与肾小球数目、取材成功率的关系。结果取材标本长度与肾小球数呈非线性关系,当标本长度〈0．5cm时,标本中肾小球数和取材成功率皆明显减低;当标本长度≥0．5cm时,标本中。肾小球数和取材成功率与取材标本的长度无关。结论移植肾活检成功率与穿刺次数无关。取材标本长度≥0．5cm时,可以做为评价取材成功与否的临床指标。     

移植肾穿刺活检83例临床病理分析

目的研究移植肾在术后出现合并症时穿刺活检的病理结果,探讨其对临床的指导意义。方法对83例移植肾进行活组织检查,并进行病理学诊断与分类,结合移植后情况进行分析。结果移植肾慢性排斥反应42例（50.6%）,急性排斥反应14例（16.9%）,肾小球肾炎12例（14.5%）,肾小管药物中毒4例（4.8%）,血管性排斥反应2例（2.4%）,IgA肾病2例（2.4%）,急性肾小管损伤1例,间质纤维化1例,移植肾肾梗死1例,未见排斥反应4例。急性排斥反应14例中有6例肾小管周毛细血管C4d（＋）,阳性率达42.8%。结论移植肾活检安全可靠,是诊断术后多种合并症的有效手段;常规活检有助于及早发现不良因素。     

50例移植肾组织穿刺活检临床病理分析

目的:探讨移植肾组织穿刺活栓的临床指导意义.方法:对50例肾移植后出现血清肌酐超过正常、蛋白尿、肾小球性血尿等且依据临床资料不能确诊病因者进行移植肾组织活检,并对病理学诊断与分类进行分析.结果;病理学检查确诊慢性排斥反应20例,其中7例病理检查提示同时存在急性排斥反应;急性排斥反应10例,肾小管药物毒性8例,系膜增生性肾炙4例,IgA肾病3例,加速性排斥反应2例,急性肾小管坏死2例.膜性肾病1例.结论:移植肾组织活检安全,可靠,可为临床移植肾疾病的诊断提供可靠组织学和细胞学依据,有助于临床正确诊断及治疗.     

移植肾穿刺组织病理学检查及临床分析

目的:探讨移植肾术后组织病理穿刺活检对临床诊断与治疗的指导意义.方法:肾移植术后患者82例,行常规穿刺组织病理活栓,依据Banff'05标准进行病理分型,通过移植肾的病理状态明确诊断,并进行相应临床治疗,观察治疗效果.结果:81例诊断明确,1例因获取组织量较少难以诊断.82例患者中31例肾功能延迟恢复,其中28例移植肾功能恢复,3例移植肾功能至今未恢复;51例血肌酐水平升高者经治疗后44例血肌酐水平呈不同程度下降,3例慢性移植肾功能不全,4例血肌酐稳定于较高水平.结论:移植肾穿刺组织病理活检安全、可靠,对患者及移植肾无不良影响,对肾移植术后移植肾功能不全的辅助诊断和治疗有重要意义.     

移植肾穿刺活组织检查:72例的病理及临床分析

背景:肾移植后慢性排斥反应及各种移植肾病变是移植肾失功能的常见原因,但对移植肾予以准确评估往往非常困难,活检仍是目前的主要手段.目的:分析肾移植后出现合并症时移植肾穿刺活检的病理结果.方法:对72例移植肾进行肾穿刺活组织检查,并进行病理诊断及分类,结合移植后情况进行分析.结果与结论:72例中发生急性细胞介导性排斥反应35例,急性抗体介导性排斥反应12例,移植肾急性药物毒性损伤10例,慢性T细胞介导性排斥反应6例,慢性抗体介导性排斥反应2例,急性肾小管坏死4例,慢性移植肾肾病3例.移植肾组织活检的病理报告与穿刺前临床诊断的符合率在75%以上.移植肾穿刺活检未发生明显的不良反应.提示移植肾活检安全可靠,对肾移植后难以根据临床化验资料作出准确判断肾脏损害的并发症及治疗方案的选择有极为重要的指导意义.     

移植肾穿刺活组织检查：72例的病理及临床分析

背景：肾移植后慢性排斥反应及各种移植肾病变是移植肾失功能的常见原因,但对移植肾予以准确评估往往非常困难,活检仍是目前的主要手段。目的：分析肾移植后出现合并症时移植肾穿刺活检的病理结果。方法：对72例移植肾进行肾穿刺活组织检查,并进行病理诊断及分类,结合移植后情况进行分析。结果与结论：72例中发生急性细胞介导性排斥反应35例,急性抗体介导性排斥反应12例,移植肾急性药物毒性损伤10例,慢性T细胞介导性排斥反应6例,慢性抗体介导性排斥反应2例,急性肾小管坏死4例,慢性移植肾肾病3例。移植肾组织活检的病理报告与穿刺前临床诊断的符合率在75%以上。移植肾穿刺活检未发生明显的不良反应。提示移植肾活检安全可靠,对肾移植后难以根据临床化验资料作出准确判断肾脏损害的并发症及治疗方案的选择有极为重要的指导意义。     

移植肾超声研究进展

肾移植是治疗终末期肾脏疾病的有效方法,但肾移植术后排异和各种并发症常导致移植肾功能障碍和丧失,移植肾排异和与移植有关的并发症常表现为形态改变、血供缺失和血流动力学紊乱。超声检查由于可同时提供移植肾形态学和血液循环状况方面的信息,已成为肾移植术后监测的重要组成部分。移植肾超声研究进展与超声技术的发展密不可分,本文概述二维超声、彩色多普勒超声的研究成果,着重论述新技术对移植肾研究的进展。1概述1.1正常声像图移植肾多置于患者右髂窝,位置表浅且几乎不受呼吸影响,故移植肾成像较原位肾清晰,呈椭圆形,边界规整。肾内皮…     

三维超声动态观察移植肾体积变化及其临床意义

目的:探讨三维超声观察移植肾的体积变化及其临床意义。方法:利用三维超声体元模型法重建移植肾进行体积测量,对9例移植肾进行了动态观察,随访期1年。同时利用二维超声椭圆体积法计算肾脏的体积;利用多普勒超声在移植肾不同部位采样测量阻力指数(RI)和波动指数(PI)。比较几项指标的变化情况及临床意义。结果:9例患者共发生排异反应7次。出现排异反应时,肾脏体积均增大,增大率为18%±10%,范围7%~36%,抗排异治疗后,肾脏体积复原,非排异反应期间,肾脏体积较稳定。三维体积测量较二维测量有更好的稳定性和重复性。移植肾早期,RI值均较高,以后逐渐降低,大约6个月后趋于稳定。结论:三维体元模型法体积测量能够较敏感地反映移植肾体积的变化,动态观察移植肾体积的变化有助于排异反应的诊断和抗排异疗效判定。     

胰肾联合移植的超声观察

目的　探讨胰肾联合移植的声像图特征。方法　对 3例胰肾联合移植患者行超声检测。结果　移植胰、肾术后短期内内部回声极低 ,形态饱满 ,1～ 3月内胰头、胰尾相对较大 (P <0 .0 1或0 .0 5) ;移植胰周围及腹腔内可出现局限性积液。移植胰、肾动、静脉显示清晰 ,供胰动脉Vmax(63 .3±1 2 .5)cm/s,RI=0 .68± 0 .0 7,主肾动脉Vmax(71 .0± 2 9.9)cm/s,RI =0 .73± 0 .0 6。结论　超声检测移植胰、肾图像清晰 ,操作方便 ,无创 ,可反复检查 ,但对检测移植胰排异反应无特异性 ,可通过观察移植肾血流变化 ,了解是否存在胰排异反应     

Emerging trends in infections among renal transplant recipients

Outcomes following renal and simultaneous kidney–pancreas transplants have improved significantly due to better surgical techniques and improved modalities of antirejection therapy. However, infection remains a significant cause of morbidity and mortality. The use of new modalities of immunosuppression and routine use of antimicrobial prophylaxis has changed the pattern of infections post-transplantation. Cytomegalovirus remains a significant problem and BK virus has emerged as an important pathogen. New antimicrobial agents are now available to treat infection, however, antimicrobial resistance remains a concern.     

Double-blind study of interferon administration in renal transplant recipients

Abstract. In a double-blind trial renal allograft recipients were treated with fibroblast interferon preparations for 3 months in an attempt to prevent viral infections. Interferon therapy did not reduce the overall incidence of viral infections. No adverse effects were noted on liver function, platelet counts. or leucocyte counts, or acute rejection episodes.     

Double-blind study of interferon administration in renal transplant recipients.

In a double-blind trial renal allograft recipients were treated with fibroblast interferon preparations for 3 months in an attempt to prevent viral infections. Interferon therapy did not reduce the overall incidence of viral infections. No adverse effects were noted on liver function, platelet counts, or leucocyte counts, or acute rejection episodes.     

TPMT genotype and its clinical implication in renal transplant recipients with azathioprine treatment

BACKGROUND: Thiopurine S-methyltransferase (TPMT) catalyses the S-methylation of thiopurine drugs. Patients with intermediate or deficient TPMT activity are at risk of toxicity after receiving standard doses of these drugs. OBJECTIVE: This study determined the frequencies of TPMT alleles (TPMT*2, *3A, *3B and *3C) and explored the association between TPMT genetic polymorphism and the development of adverse drug reactions in Chinese renal transplant patients receiving azathioprine (AZA). METHODS: TPMT genotypes were determined using polymerase chain reaction-based assays in 122 renal transplant patients and 210 healthy subjects. Biochemical and clinical data were retrospectively evaluated after renal transplantation. RESULTS: Of 122 patients, eight (allele frequency 3.28%) were heterozygous for TPMT*3C and no TPMT*2, *3A or *3B or homozygous TPMT*3C subjects were identified. The pattern and frequency of the main mutant TPMT alleles were similar in patients and healthy subjects. Four of five patients (80%) with haematopoietic toxicity were heterozygotes. TPMT heterozygosity was associated with significant reductions in haematological indices and a significant decrease in cyclosporine plasma concentrations in the first year after renal transplantation. No association between TPMT genotype and renal rejection was identified. CONCLUSION: Our results, together with those of others pointing in the same direction, suggest that genotyping the major TPMT variant alleles may be a valuable tool in preventing AZA toxicity and optimization of immunosuppressive therapy.     

分阶段健康教育对肾移植患者康复的影响

目的探讨分阶段健康教育对肾移植患者康复的影响。方法选取2010年12月—2012年7月上海市闸北区中心医院收治的肾移植患者195例,其中以2010年12月—2011年9月收治的肾移植患者96例为对照组,以2011年10月—2012年7月收治的肾移植患者99例为观察组。对照组给予传统健康教育;观察组根据移植术后时间,在术后3个月、3~6个月和6个月这3个阶段,进行有针对性的健康教育,包括心理干预、正确用药指导、饮食指导及规律运动等。观察两组患者遵医依从性、相关并发症以及满意度。结果观察组患者的遵医依从性及满意度与对照组比较,差异有统计学意义(P0.05);观察组患者肾移植术后无感染、高血压和心力衰竭等并发症发生,对照组中17例患者出现不同程度的并发症。结论对肾移植患者实施分阶段、有针对性的健康教育是根据肾移植患者康复期的特点制订的有重点、操作性强的健康教育内容,有助于提高患者的遵医依从性,改善患者对疾病的自我管理行为,对促进肾移植患者早日康复起到了积极作用。     

肾移植受者血清C-反应蛋白动态变化及意义

目的　观察肾移植受者血清 C-反应蛋白 (C- reactive protein,CRP)的动态变化 ,探讨 CRP与急性排斥的关系。方法　以透射比浊法检测 6 0例肾移植受者术前和术后不同时间血清中 CRP浓度 ,并同时检测尿素氮 (Bun)、肌酐 (creatine,Cr)的水平 ,以 5 0例健康献血者作对照。结果　肾移植受者术前 CRP水平 (2 .5 9± 0 .5 5 ) m g/L 与正常对照组 (2 .18± 0 .5 7)mg/L 相比 ,差异无显著性 (P>0 .0 5 ) ,而术后 1d CRP明显升高至 (2 0 .2 1± 4 .87) mg/L,并于第 2天达峰值 (2 9.30± 6 .4 4 )mg/L,第 4天开始下降 ,至第 8天恢复至接近术前水平 (8.0 2± 1.30 ) m g/L,CRP的总体变化趋势与肾功能改善基本一致 ,发生急性排斥者的 CRP均有一个明显上升过程 ,应用免疫抑制剂冲击治疗后大部分迅速下降。结论　血清 CRP动态变化与急性排斥反应的发生及免疫抑制剂冲击治疗的效果密切相关     

肾移植术后性功能调查情况分析

目的 探讨肾移植后病人的性功能状况。方法 对肾移植成功后存活3个月以上患者21例,进行性功能状况调查。结果 移植术后性功能明显改善。结论 成功的肾移植是使慢性肾衰患者重新获得性功能的最有效的治疗手段。     

Cyclosporine monitoring in renal transplant recipients with induction therapy: C2 levels in patients monitored on C0

The aim of this retrospective study was to compare the cyclosporine C(2) blood levels in renal transplant recipients with induction therapy, monitored on C(0) levels during the early and long-term post-transplantation periods in different French transplantation centres, to the target values recommended by the International Consensus on Neoral and used in the Mo2art study. A retrospective study was conducted by the therapeutic drug monitoring (TDM) committee of the French Pharmacological Society. Cyclosporine C(0) and C(2) concentrations from 168 renal transplant recipients were collected at different post-transplantation periods by six TDM laboratories of transplantation centres from April 2001 to April 2002. Cyclosporine blood levels were determined by fluorescence polarization immunoassay (mFPIA, AxSYM, Abbott) or enzyme immunoassay (EMIT, Dade Behring). Most patients had C(0) values in the recommended target ranges, with C(2) levels below the targets used in the Mo2art study or proposed by the International Consensus Conference, both during the early and long-term post-transplantation periods. Sixty-eight per cent of patients had C(2) below 1,500 microg/L +/- 20% in the first 2 months post-transplantation and 55% had C(2) below 800 microg/L +/- 20% in the late post-transplantation period (>1 year). Cyclosporine dose should be increased by 40% on average during the first week post-transplantation period and by 50% during the maintenance period to achieve the C(2) targets. In France, most renal transplant recipients receiving induction agents monitored on C(0) had C(2) levels below the targets recommended by the International Consensus Conference. In clinical practice, the optimal therapeutic windows for CsA monitoring based on C(2) needs to be more precisely defined, both during the early and long-term post-transplantation periods in renal transplant recipients receiving induction agents.