非清髓异基因外周造血干细胞移植治疗高龄血液病临床研究

目的 探讨非清髓异基因外周造血干细胞移植(NAST)在治疗高龄血液病中的作用。方法 采用NAST、治疗高龄血液病患者5例。5例患者平均年龄55岁(53～59岁)。预处理方案主要由环孢素、抗淋巴细胞球蛋白和环磷酰胺等组成。结果 5例患者均顺利度过移植后造血抑制期，3例供者细胞完全植入，2例为供受者混合嵌合体。2例出现移植物抗宿主病(GVHD)，治疗后好转。结论 NAST简便安全，并发症少，疗效好，为高龄血液病的治疗开辟了新途径。     

非清髓异基因造血干细胞移植后急性白血病复发5例报告

目的 研究分析非清髓异基因外周造血干细胞移植(NAST)后急性白血病复发的相关因素。方法 29例急性白血病患者NAST后5例复发，男2例，女3例，中位数年龄36岁(18～59岁)。非清髓预处理方案：环磷酰胺、阿糖胞苷及CD3单克隆抗体，3例患者在此基础上加用氟达拉滨。结果 5例均顺利渡过造血抑制期。2例早期形成供者造血细胞完全嵌合体(FDC)并在FDC状态下复发。3例移植早期形成供受者混合造血细胞嵌合体(MC)，2例转为FDC后复发，1例在稳定MC状态下复发。5例中4例复发前无急性或慢性移植物抗宿主疾病(GVHD)，另1例NAST后发生Ⅱ度aGVHD并在皮肤慢性GVHD未治愈状态下复发。5例中1例行2次NAST治疗，在第2次完全缓解，但于2个月后再次复发，放弃治疗。另4例未再继续治疗，2例分别于复发后1和2个月死亡，2例仍带病存活。结论 NAST简便安全，并发症少，白血病复发率无明显升高，为治愈白血病提供了新手段。     

非清髓异基因造血干细胞移植——造血干细胞移植的新方向

简述了国内外刚刚开展的非清髓异基因造血干细胞移植（NAST）的主要研究进展和研究方向。对NAST的概念、预处理方案、移植物抗宿主病预防、移植物抗白血病效应及临床应用等问题作了讨论和介绍。并提出NAST是对传统异基因造血干细胞移植理论和观念的发展及更新,为血液病、恶性肿瘤及免疫、遗传性疾病的治疗开辟了新路径。并建议加强对NAST有关问题的协作研究。     

临床小肠移植排斥反应的防治

采用环孢素Ａ、雷公藤多甙、甲基氢化泼尼松、前列腺素Ｅ１伍用的新型免疫抑制方案，预防小肠移植排斥反应取得满意效果。病人存活３１０ｄ。经验表明，通过内窥镜和肠粘膜组织病理检查，监测排斥反应简便实用有效。利用聚合酶链反应（ＰＣＲ）技术研究发现，移植术后供肠细胞向受体组织移居嵌合，而临床无移植物抗宿主病（ＧＶＨＤ）发生。促进细胞移居嵌合可能有利于防止排斥反应的发生。     

彩色多普勒超声在西宁地区移植肾排斥反应中的应用

目的：总结我院30例移植肾超声特点,探讨彩色多普勒超声在西宁地区移植肾排斥反应的诊断价值。方法：应用超声对30例移植肾和30例正常人肾脏各级肾动脉血流参数进行对比研究。结果：肾功能稳定期：四级肾动脉血流参数与正常组无明显差别;急性排斥反应期：动脉血流阻力指数（RI）和动脉搏动指数（PI）早期明显增高、收缩期血流速度与舒张期血流速度比（S/D）升高（P〈0.05）。急性排斥反应期,给予有效治疗后,各级肾动脉血流参数均有改善。早期移植肾急性排斥正确诊断率达89.2%。慢性排斥反应期：RI和PI增高（P〈0.01）;叶间动脉舒张期：血流频谱很低甚至无频谱信号。结论：应用彩色多普勒超声诊断移植肾排斥反应并监测其功能恢复,具有快速、准确、无创伤、直观等优点,可提早发现病情变化,对临床治疗和监测排斥反应具有指导意义。     

STR—PCR定量检测供受者嵌合体方法的建立及临床应用

利用STRs的高度多态性等特性,用竞争性聚合酶链反应（PCR）结合聚丙烯凝胶电泳、染色和凝胶成像分析等技术,建立定量检测异基因造血干细胞移植后供受者嵌合体的方法,用无关个体的DNA混合实验进行可行性和准确性研究,并同时做染色体分带进行对照,以此基础上对2例非清髓异基因造血干细胞移植病人的植入情况进行动态检测。结果显示,扩增产物中供受者DNA含量的百分比同扩增前混合样本的比例呈显著直线相关,STR－PCR检测嵌合体方法简单、快速、可靠、敏感性高,所需标本量少且不受性别限制,是检测NAST供受者嵌合体的新方法。     

全小肠移植术后移植肠功能的恢复

国内首例全小肠移植患者移植肠功能完全恢复，表现为：完全停止静脉营养，恢复口服饮食维持营养良好。肠道对糖、氨基酸的吸收能力恢复正常。大便成形，２－３／ｄ。移植肠形态结构正常，无排斥及ＧＶＨＤ发生，运动及屏障功能正常。促进和维护移植肠功能的恢复，应缩短缺血时间，熟练血管吻合技术，积极防治排斥及感染，保护肠屏障功能等。     

影响移植肾早期功能恢复的因素探讨

影响移植肾早期功能恢复的因素探讨５１０５１５广州第一军医大学南方医院史跃先，于力新，罗永礼，周展眉，张训中国图书资料分类号Ｒ３９２．４肾移植术后供肾的早期功能恢复与预后有直接关系。随着环抱素Ａ（ＣｓＡ）及其它兔疫抑制剂的应用，急性排异反应得以有效控制...     

烧伤后皮肤混合移植中局部免疫抑制的研究

目的 探讨混合皮肤移植的免疫学机制。方法 建立烧伤大鼠混合皮肤移植的动物模型及模拟混合皮肤移植的烧伤患者淋巴细胞，异体表皮细胞，自体表皮细胞的混合培养体系。进行大体和病理观察，淋巴细胞的增殖反应，细胞免疫和体液免疫指标的检测。结果 （１）组织学检查显示，异体移植于术后１４－２１天遭排斥，混合移植处未见明显排异反应。（２）体外模拟混合移植实验中，自体淋巴细胞对异体表皮细胞的免疫庆答强度明显减弱。（３     

胰腺移植急性排斥反应的监测

探讨如何监测胰腺十二指肠移植急性排斥反应 ,用 12头猪作同种异体胰腺十二指肠移植 ,其中 6头术后抗排斥治疗 1周。定期取胰腺组织病理检查确定有无急性排斥反应 ,定期检测胰腺淀粉酶分泌量 ,血清TNF α和一氧化氮 (NO)变化。结果显示 ,一旦发生胰腺急性排斥反应 ,淀粉酶分泌急剧下降 ,TNF α及NO则明显升高 ,与急性排斥反应发生前比较有显著差异 (P <0 .0 1)。提示胰液淀粉酶分泌量、血清TNF α和NO均可用于监测胰腺急性排斥反应 ,指导适时进行胰腺活检早期诊断。     

MR (1.5 T) in the evaluation of pancreas transplant rejection

Graft rejection is the major cause of graft loss following pancreatic transplantation. Early detection of the rejection process is of great importance towards planning effective treatment when transplant recipients present with aspecific clinical findings suggesting rejection. Up to date, the demonstration of pancreatic transplant rejection has been attempted with nuclear medicine and sonography (US). The authors studied high-field (1.5 T) MR potentials in pancreatic transplantation and rejection and correlated MR findings with clinical and laboratory data. Eleven MR scans were obtained from 4 patients with suspected pancreatic graft rejection, and 9 MR images from 4 patients with normal pancreatic allografts. Qualitative image evaluation showed the pancreatic tissue of the patients diagnosed with rejection to be hypointense on T1-weighted scans and highly hyperintense on T2-weighted scans, as compared to normal grafts. Quantitative data were obtained by comparing the signal intensity of pancreatic grafts to that of the nearby muscle. On both T1- and T2-weighted images, pancreatic tissue/muscle signal-intensity ratios were significantly different, in rejecting transplants, from those of normal allografts (p less than 0.001). Our qualitative and quantitative findings suggest the use of MR imaging as a reliable means of detecting pancreatic graft rejection.     

Renography and biopsy-verified acute rejection in renal allotransplanted patients receiving cyclosporin A

Acute impairment of renal function caused by cyclosporin A can be hard to differentiate from acute rejection. Therefore, kidney function after cadaveric allograft transplantation was repeatedly determined by renography in 42 patients receiving either high dose cyclosporin A (32 patients) or azathioprine and prednisone (10 patients) until a graft biopsy showed either acute rejection or no rejection within the first 5 postoperative weeks. The graft function as judged from the renograms was significantly poorer when cyclosporin A was used than when azathioprine and prednisone were the immunosuppressants. In the azathioprine and prednisone group a biopsy showing acute rejection was always preceded by a deterioration in the renogram. In cyclosporin A treated patients a graft biopsy following an early deterioration in the renogram showed acute rejection in only 56% of the biopsies. It was not possible to identify a time course or a function level of the renogram that could predict rejection in these patients. It is concluded that graft biopsies should be used liberally to diagnose rejection during cyclosporin A treatment if surgical complications after transplantation have been ruled out. Radionuclide studies may offer an invaluable aid in determining a nonnephrotoxic initial dose of the drug.     

基因水平HLA—DR相容对移植肾急性排斥和存活率的影响

回顾性分析基因水平HLA-DR相容对移植肾急性排斥和存活率的影响。318例接受环孢菌素A治疗的首次尸肾移植,DR分型采用PCR-SSP方法。分析DR相容对早期肾功能、急性排斥与激素治疗和1年存活率的影响。结果显示HLA-DR基因分型均获成功,耗时4h。318例受者中达到0MM者占11.6%、1MM占51.9%、2MM占36.5%,总体排斥率49.1%,1年人/肾存活率94.3%、90.3%。DR相容者,早期肾功能、急性排斥与激素治疗、移植肾存活均明显优于配型差的受者,具有统计学差异。提示基因水平HLA-DR相容对尸肾移植急性排斥和存活率具有重要影响。     

Renography and biopsy-verified acute rejection in renal allotransplanted patients receiving cyclosporin A

Acute impairment of renal function caused by cyclosporin A can be hard to differentiate from acute rejection. Therefore, kidney function after cadaveric allograft transplantation was repeatedly determined by renography in 42 patients receiving either high dose cyclosporin A (32 patients) or azathioprine and prednisone (10 patients) until a graft biopsy showed either acute rejection or no rejection within the first 5 postoperative weeks. The graft function as judged from the renograms was significantly poorer when cyclosporin A was used than when azathioprine and prednisone were the immunosuppressants. In the azathioprine and prednisone group a biopsy showing acute rejection was always preceded by a deterioration in the renogram. In cyclosporin A treated patients a graft biopsy following an early deterioration in the renogram showed acute rejection in only 56% of the biopsies. It was not possible to identify a time course or a function level of the renogram that could predict rejection in these patients. It is concluded that graft biopsies should be used liberally to diagnose rejection during cyclosporin A treatment if surgical complications after transplantation have been ruled out. Radionuclide studies may offer an invaluable aid in determining a nonnephrotoxic initial dose of the drug.     

Outcome of kidney transplantation in patients on peritoneal dialysis]

The initial experience suggested that kidney transplantation could be hazardous for patients on peritoneal dialysis due to the high risk of peritonitis and a possible high incidence of acute rejection. In this paper we have presented our experience with kidney transplantation in these patients. During the last four years kidney transplantation was performed in 9 patients on peritoneal dialysis. The average time spent on peritoneal dialysis was 20.6 +/- 7.6 months. In all patients peritoneal catheter was removed during the surgery. During the posttransplantation period a triple immunosuppressive therapy including steroids, cyclosporin and azathioprineor mycophenolate mofetil was administered in all patients. In comparison to patients on hemodialysis no significant difference in the incidence of acute rejection episodes, delayed graft function, graft arterial thrombosis and graft function recovery was observed. Patients on peritoneal dialysis had significantly greater and longer wound drainage in comparison to patients on hemodialysis. It was concluded that peritoneal dialysis had no negative influence on short-term outcome of kidney transplantation.     

Analysis of a 4-year follow-up of the results of kidney transplantation from living related donors

The aim was to present a four-year experience in living related kidney transplantation. A total of 43 patients (9 females and 34 males) were enrolled in this study. The standard triple immunosuppressive therapy (steroids, azathioprine and cyclosporine) was administered in 19 (44.1%) patients, and in 20 (46.5%) mycophenolate mophetil in daily dose of 2 g instead of azathioprine. In 5 (14.2%) patients with high immunological risk and delayed graft function was administered antithymocite globulin in duration of 7-14 days, prophylactically. In 3 (6.97%) patients graft loss was caused by vascular complications and in 1 (2.32%) by infection as the complication. During the first post-transplantation year acute rejection was noticed in 8 (34.7%) patients and in 3 (37.5%) it was steroid resistant. The graft loss was never caused by acute rejection. Six-months graft survival was noticed in 91.1% patients and one-year graft survival in 88.4% patients. One-year patient survival was 100%. Short term results in living related kidney transplantation are excellent and nowadays, due to improvement in immunosuppressive therapy, the success in this type of kidney transplantation is mainly limited by surgical and infective complications.     

Changes in transplanted kidney volume measured by ultrasound

A simple ultrasonic method was used for measuring transplanted kidney volume in 29 patients. Five of these patients developed diabetes mellitus and six women became pregnant following transplantation. Serial measurements were performed over periods of 6-12 months after transplantation. The kidney volume became stable 6 months after transplantation and this volume correlated positively with the renal function. Renal hypertrophy was noted in those transplant patients who developed diabetes mellitus following transplantation and this hypertrophy was associated with improvement in graft function. Transplant volume also rose in acute rejection and returned to normal after appropriate treatment. During pregnancy following transplantation, the transplant volume increased early in pregnancy to return to normal before delivery. This volume increase was also associated with graft function improvement.     

肾移植后血中内皮素和一氧化氮检测的临床意义

探讨肾脏移植后测定内皮素－１（ＥＴ－１）和一氧化氮（ＮＯ）的临床意义。对４７例肾脏移植病人进行外周血中ＥＴ－１和ＮＯ动态检测,将检测结果以移植肾善和血压值分别分组进行比较。移植后与尿毒症组相比较,ＥＴ－１值明显下降（Ｐ〈０．０１）,ＮＯ值明显升高（Ｐ〈０．０１）,急性排斥发生时ＮＯ值升高（Ｐ〈０．０５）,慢性排斥时ＥＴ－１值较肾功能稳定时明显升高（Ｐ〈０．０１）。高血压组的ＥＴ－１值较高而ＮＯ水平     

Pancreatic transplant imaging

Forty-four clinical episodes of suspected (pancreas) transplant rejection in 17 pancreatic transplantation patients were reviewed retrospectively. The clinical impression of acute graft rejection, chronic rejection, or nonrejection in each episode was correlated with the results of 19 nuclear medicine, 12 ultrasound (US), and 44 magnetic resonance (MR) imaging studies. US was found to be a moderately sensitive (82%) method of detecting graft rejection. US also was effective in identifying intra- and peripancreatic fluid accumulations. Nuclear medicine imaging was also a sensitive technique (86%) and the only modality that provided physiologic information regarding graft perfusion. MR imaging allowed correct prediction of the presence or absence of graft rejection in 39 of 44 cases (sensitivity, 100%; specificity, 76%) and was an effective means of detecting pathologic fluid collections. Nuclear medicine, US, and MR imaging are all believed to be sensitive methods of detecting graft rejection and are complementary adjuncts to the clinical evaluation of pancreatic transplants.     

Intrarenal backflow during retrograde pyelography following kidney transplantation

At the transplantation center of Rigshospitalet , Copenhagen, retrograde pyelography is routinely performed via a ureteral catheter inserted during the operation. Ninety-nine retrograde pyelographies performed within the first days after renal transplantation were reviewed. The clinical records of 30 additional patients who had not been subjected to pyelography were also reviewed. Intrarenal backflow (IRB) was seen in 14 per cent of the pyelograms. Upper urinary tract obstruction (29 cases) was observed with equal frequency in the groups with and without IRB. No relationship was observed between IRB and length of warm and cold ischemia of the graft, urinary tract infection (UTI), donor kidney age and graft function on the day of retrograde pyelography. In 40 per cent of the grafts with irreversible rejection within 60 days after transplantation IRB was found at pyelography in the first days after operation. IRB occurred in only 5 per cent of the kidneys with good long term function. Most frequently IRB was localized to the upper pole but was also observed in other parts of the kidney. IRB may be an early radiographic sign of an impending and irreversible graft rejection. There was no evidence that retrograde pyelography increased the frequency of UTI or the number of episodes of irreversible rejection.