亲属活体肾移植(附162例报告)

目的探讨亲属活体肾移植的疗效。方法亲属活体肾移植162例,除7例为夫妻间供肾外,其余为血缘亲属供肾。人类白细胞抗原(human leukocyte antigen,HLA)抗原错配5个4例、抗原错配4个6例、抗原错配3个101例、抗原错配2个51例。全部供者经开放手术取肾。受者术后采用环孢素或他克莫司+麦考酚吗乙酯+泼尼松龙三联免疫抑制治疗方案预防排斥反应。结果供者中除2名出现一过性血清肌酐升高外,其余肾功能均在正常范围内。162例受者中,术后早期肾功能恢复正常157例,肾功能延迟恢复5例,急性排斥反应5例,输尿管血栓形成2例,慢性排斥反应3例。1、3、5年人存活率均为96.9%,1、3、5年肾存活率分别为96.3%、95.8%、95.0%。死亡5例,死亡时间为移植后3个月内,均死于重度肺部感染并呼吸衰竭。结论亲属活体肾移植的组织配型好,供者术前准备充分,供肾缺血时间短,受者术前有充足的免疫诱导时间,免疫抑制剂用量小,排斥反应发生率低,移植肾存活率高。     

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2508例次临床总结

目的总结肾移植的临床经验,探讨影响移植术后人／肾存活的因素,提高长期存活率。方法回顾性总结1979年1月～2008年6月2508例次肾脏移植资料,分析患者术前状况、组织配型、群体反应性抗体（PRA）、供肾的切取、灌注、热冷缺血时间、植肾技术、术后并发症的发生、不同免疫抑制剂方案、再次移植等因素对移植效果及人／肾存活率的影响。结果①移植效果：总体人／肾存活率81．4％／76．3％;近10年来,1、5、10年人／肾存活率（%）分别为：96．5／93．2、88．6／81．6和74．7／71．3;186例活体亲属供者随访均健康存活,受者1年人／肾健康存活率98．5％／95．5％;②排斥反应：超级排斥反应发生率0．7％,急性排斥反应（AR）发生率13．7％,近十年来急性排斥反应（AR）发生率7．4％;③术后并发症：发生各种感染787例,急性肾小管坏死（ATN）275例,药物毒副作用590例,肾动脉及肾破裂19例;晚期输尿管梗阻39例,恶性肿瘤28例;④死亡原因：前三位的分别是感染占47．3％,心脑血管并发症占34．8％,肝功能衰竭占10．9％。结论充分的术前准备、良好的HLA配型、加强PRA检测是提高存活率的基础;高质量的供肾和娴熟的移植技术是肾移植成功的重要保证;科学、合理、个体化的应用免疫抑制剂是移植后治疗的重点,环孢素A（CsA）或他克莫司（FK506）、霉酚酸酯（MMF）、泼尼松（Pred）三联是目前首选的免疫抑制治疗方案。加强感染的早期监测、预防性治疗是术后早期治疗的另一关键．加强患者的随访,提高患者的依从性,对指导肾移植受者长期存活具有重要价值。     

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.     

巴戟天水提取物对精索静脉曲张SD大鼠支持细胞波型蛋白表达的影响

目的探究巴戟天水提取物对精索静脉曲张SD大鼠支持细胞波型蛋白表达的影响。方法选取处于青春期的健康雄性SD大鼠40只,按照数字随机表法分为假手术组、对照组、观察1组和观察2组,按组别分别使用相应剂量的生理盐水和巴戟天水提取物灌胃,然后使用MTT法检测细胞活性,使用实时荧光定量PCR法检测mRNA相对表达量,使用Western blotting法检测波形蛋白表达。结果 4组大鼠支持细胞活性差异无统计学意义(P0.05);对照组支持细胞波形蛋白mRNA和波形蛋白表达水平显著低于假手术组(P0.05),观察1组和观察2组显著高于对照组(P0.05),并且观察2组显著高于对照组和观察1组(P0.05)。结论巴戟天水提取物具有提高精索静脉曲张SD大鼠支持细胞波形蛋白mRNA表达水平和波形蛋白表达水平的作用。     

巴戟天水提取物对精索静脉曲张SD大鼠睾丸组织中精子结合抗原11T和miR-210的影响

目的:探讨巴戟天(MOH)对精索静脉曲张(VC)SD大鼠睾丸组织精子结合抗原11T(SPAG11T)和微小RNA-210 (miR-210)的影响.方法:将40只SD大鼠随机均分为空白对照组、VC组、治疗1组、治疗2组(n=10).治疗1组给予200 mg/kg MOH水提取物灌胃,治疗2组给予400 mg/kg MO...     

苦参素注射液在慢性丙型肝炎患者肾移植术后的应用

2005年9月至2007年9月于西安交通大学第一附属医院肾移植科首次行肾移植的慢性丙肝患者55例,诊断标准参照2000年9月中华医学会传染病与寄生虫分会西安会议制定的《病毒性肝炎防治方案》,并符合下列条件：（1）抗-HCV阳性;（2）血清HCV-RNA阳性;（3）排除下列病毒感染：HAV（抗2HAV—IgM阴性）、HBV（HBsAg阴性）、HEV（抗-HEV-IgM阴性）、EB病毒（抗．EBV-IgM阴性）和巨细胞病毒（抗-MCV-IgM阴性）。     

沉默组织因子重组腺病毒的构建和胰岛中沉默效果检测

目的 构建复制缺陷型重组腺病毒介导短发夹RNA(shRNA):干扰组织因子(TF)在胰岛表达.方法 设计并合成四对单链寡核苷酸(ss oligo),经变性退火为双链寡核苷酸(ds oligo)插入穿梭质粒pENTR/U6载体,测序正确后经脂质体介导入成人胰岛,通过实时定量RT-PCR方法筛选对TF沉默效果最佳穿梭质粒pENTR/U6-shRNA,然后与腺病毒骨架质粒行同源重组.筛选出正确重组子,用293A细胞包装出表达TF-shRNA的复制缺陷型重组腺病毒并测定其病毒滴度.通过实时定量RT-PCR腺病毒沉默TF效果予以检测.结果 测序结果提示所构建的pENTR/U6-shRNA质粒正确,并从四对ds oligos筛选出对组织因子沉默效果最佳的穿梭质粒pENIR/U6-shRNA,经同源重组后成功构建了介导shRNA-TF复制缺陷型重组腺病毒.转染胰岛后,通过实时定量RT-PCR方法检测发现shRNA-TF腺病毒感染胰岛后对TF mRNA的沉默效果4 d后达最佳效果,为54.29%(P＜0.05 vs NC).结论 成功构建的介导shRNA复制缺陷型重组腺病毒可以体外抑制胰岛细胞中组织因子的表达.     

肾移植术后重症肺部感染两种治疗方案的比较

目的 :提高肾移植术后重症肺部感染的治疗水平。方法 :6 3例肾移植术后重症肺部感染患者依抗细菌方案的不同分为A、B两组 ,A组抗生素由高档到低档 ,B组与之相反 ,其余治疗不变。结果 :A组治愈率、ARDS救治成功率为 87.9%、76 .9% ,B组为 5 6 .7%、12 .5 % ;治疗中发展为ARDS、混合感染及多器官感染的例数A组为 2例、4例、4例 ,B组为 7例、10例、13例 ;A组住院天数 ( 31± 7)d ,住院费用 ( 7.3± 2 .2 )千元 ,B组为 ( 5 3± 9)d和 ( 13.9± 5 .7)千元。两组相差显著。结论 :肾移植术后重症肺部感染的治疗A方案优于B方案。     

重组腺病毒介导CD40L和CTLA4Ig的共表达和对人混合淋巴细胞反应的抑制作用

CD40／CD40L和B7／CD28是两条重要的共刺激通路，在T淋巴细胞活化过程中提供共刺激信号，在自身免疫性疾病和移植排斥反应的发生、发展过程中起重要作用，干预其相互作用，可有效地预防和治疗自身免疫性疾病和排斥反应。本研究基于我们构建的重组腺病毒CIMOL-IRES-CTLA4Ig，观察其体外的共表达情况和对人外周血混合淋巴细胞反应（MLR）的作用。