中国组织工程研究与临床康复
中國組織工程研究與臨床康複
중국조직공정연구여림상강복
JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
2007年
38期
7685-7688
,共4页
肾移植%泌氢功能%排斥反应
腎移植%泌氫功能%排斥反應
신이식%비경공능%배척반응
背景:移植后的急性排斥是肾移植术后的主要并发症,也是导致慢性排斥反应和移植物失功最重要的危险因素,因此,了解肾小管泌氢功能能否早期反映移植物的功能情况有重要意义.目的:观察肾移植患者术后肾小管泌氢功能,并进行监测,探讨其在移植物急慢性排斥中的作用.设计:病例-对照观察.单位:解放军济南军区总医院泌尿外科.对象:选择2000-05/2005-06解放军济南军区总医院泌尿外科连续实施肾脏移植26例患者,男16例,女10例;年龄21～58岁,平均35岁.原发病均为慢性肾小球肾炎,慢性肾功能衰竭,全部为尸肾移植.供受者均血型相同、淋巴细胞毒试验阴性.其中1例为第2次移植.所有患者对检测项目知情同意.方法:依据典型的临床表现,彩色多普勒超声及血流变化诊断患者排斥反应,16例患者未发生排斥反应为稳定组,10例发生排斥反应的患者为排斥组,排斥组根据排斥情况分为排斥前期、排斥期及恢复期.对所有患者术前及术后1周起每周1次,连续10周分别以化学清洁玻璃瓶留取晨起中段尿测定尿可滴定酸、NH4+和净酸水平评估肾小管泌氢功能.主要观察指标:两组患者尿可滴定酸、NH4+和净酸水平.结果:纳入患者26例均进入结果分析.排斥反应组排斥前期患者肾小管泌氢功能各检测值显示泌氢功能开始建立,并趋向正常,排斥期患者肾小管泌氢功能检测值均显示明显下降,与排斥前期及稳定组比较均有统计学显著性差异(P＜0.01).恢复期患者排斥反应治疗后监测的结果显示泌氢功能恢复较快.肾小管泌氢功能总体连续观察结果显示总体恢复的不均衡性,大部分病例恢复时间从1～10周不等,平均恢复期限约6周,2例10周内未恢复,4例严重排斥者中3例治疗后泌氢功能恢复缓慢.结论:肾小管泌氢功能可弥补血清肌酐不能良好反映肾小管功能的不足,能在连续观察中对移植肾急性排斥反应的诊断,特别是对抗排斥治疗的效果判断和预后评估中作为有价值的指标.
揹景:移植後的急性排斥是腎移植術後的主要併髮癥,也是導緻慢性排斥反應和移植物失功最重要的危險因素,因此,瞭解腎小管泌氫功能能否早期反映移植物的功能情況有重要意義.目的:觀察腎移植患者術後腎小管泌氫功能,併進行鑑測,探討其在移植物急慢性排斥中的作用.設計:病例-對照觀察.單位:解放軍濟南軍區總醫院泌尿外科.對象:選擇2000-05/2005-06解放軍濟南軍區總醫院泌尿外科連續實施腎髒移植26例患者,男16例,女10例;年齡21～58歲,平均35歲.原髮病均為慢性腎小毬腎炎,慢性腎功能衰竭,全部為尸腎移植.供受者均血型相同、淋巴細胞毒試驗陰性.其中1例為第2次移植.所有患者對檢測項目知情同意.方法:依據典型的臨床錶現,綵色多普勒超聲及血流變化診斷患者排斥反應,16例患者未髮生排斥反應為穩定組,10例髮生排斥反應的患者為排斥組,排斥組根據排斥情況分為排斥前期、排斥期及恢複期.對所有患者術前及術後1週起每週1次,連續10週分彆以化學清潔玻璃瓶留取晨起中段尿測定尿可滴定痠、NH4+和淨痠水平評估腎小管泌氫功能.主要觀察指標:兩組患者尿可滴定痠、NH4+和淨痠水平.結果:納入患者26例均進入結果分析.排斥反應組排斥前期患者腎小管泌氫功能各檢測值顯示泌氫功能開始建立,併趨嚮正常,排斥期患者腎小管泌氫功能檢測值均顯示明顯下降,與排斥前期及穩定組比較均有統計學顯著性差異(P＜0.01).恢複期患者排斥反應治療後鑑測的結果顯示泌氫功能恢複較快.腎小管泌氫功能總體連續觀察結果顯示總體恢複的不均衡性,大部分病例恢複時間從1～10週不等,平均恢複期限約6週,2例10週內未恢複,4例嚴重排斥者中3例治療後泌氫功能恢複緩慢.結論:腎小管泌氫功能可瀰補血清肌酐不能良好反映腎小管功能的不足,能在連續觀察中對移植腎急性排斥反應的診斷,特彆是對抗排斥治療的效果判斷和預後評估中作為有價值的指標.
배경:이식후적급성배척시신이식술후적주요병발증,야시도치만성배척반응화이식물실공최중요적위험인소,인차,료해신소관비경공능능부조기반영이식물적공능정황유중요의의.목적:관찰신이식환자술후신소관비경공능,병진행감측,탐토기재이식물급만성배척중적작용.설계:병례-대조관찰.단위:해방군제남군구총의원비뇨외과.대상:선택2000-05/2005-06해방군제남군구총의원비뇨외과련속실시신장이식26례환자,남16례,녀10례;년령21～58세,평균35세.원발병균위만성신소구신염,만성신공능쇠갈,전부위시신이식.공수자균혈형상동、림파세포독시험음성.기중1례위제2차이식.소유환자대검측항목지정동의.방법:의거전형적림상표현,채색다보륵초성급혈류변화진단환자배척반응,16례환자미발생배척반응위은정조,10례발생배척반응적환자위배척조,배척조근거배척정황분위배척전기、배척기급회복기.대소유환자술전급술후1주기매주1차,련속10주분별이화학청길파리병류취신기중단뇨측정뇨가적정산、NH4+화정산수평평고신소관비경공능.주요관찰지표:량조환자뇨가적정산、NH4+화정산수평.결과:납입환자26례균진입결과분석.배척반응조배척전기환자신소관비경공능각검측치현시비경공능개시건립,병추향정상,배척기환자신소관비경공능검측치균현시명현하강,여배척전기급은정조비교균유통계학현저성차이(P＜0.01).회복기환자배척반응치료후감측적결과현시비경공능회복교쾌.신소관비경공능총체련속관찰결과현시총체회복적불균형성,대부분병례회복시간종1～10주불등,평균회복기한약6주,2례10주내미회복,4례엄중배척자중3례치료후비경공능회복완만.결론:신소관비경공능가미보혈청기항불능량호반영신소관공능적불족,능재련속관찰중대이식신급성배척반응적진단,특별시대항배척치료적효과판단화예후평고중작위유개치적지표.
BACKGROUND: Acute rejection is a main complication and the major risk factors of chronic rejection and chronic graft dysfunction (CGD) after renal transplantation. Therefore, it is significant to investigate the effect of hydrogen ion excretion of renal tubule on the early diagnosis of the dysfunction of graft in renal transplantation patients.OBJECTIVE: To explore the effect of the hydrogen ion excretion of renal tubule on the diagnosis and efficacy of acute and chronic rejection of graft after renal transplantation.DESIGN: Case-controlled observation.SETTING: Department of Urinary Surgery, General Hospital of Jinan Military Area Command of Chinese PLA.PARTICIPANTS: A total of 26 patients after successive renal transplantation were enrolled at Department of Urinary Surgery, General Hospital of Jinan Military Area Command of Chinese PLA from May 2000 to June 2005. The age of all patients ranged from 21-58 years with an average of 35 years, including 16 males and 10 females. Recipients' primary diseases were chronic glomerulonephrltis (CGN) and chronic renal function failure (CRF). One patient was in the 2nd transplantation. All patients received cadaveric renal transplantation. Donors and recipients had the same blood type and negative of lymphocytotoxicity test. All patients singed the informed consent.METHODS: According to clinical symptoms and bloodstream tested by color Doppler ultrasound, 16 patients without rejection were considered as stabilization group and 10 patients with rejection as rejection group. The rejection group was divided into prerejection, rejection and recovery phases. Medistream urine was collected with clean chemical glass bottle in the morning before operation and at week 1 after operation, once a week for successively 10 weeks. Urine titratable acid, NH+4 and net acidity levels were measured to evaluate hydrogen ion excretion of renal tubule.MAIN OUTCOME MEASURES: Urine titratable acid (TA), NH+4 and net acid excretion capacity (NAC) levels of patients in the two groups.RESULTS: Totally 26 patients were involved in the result analysis. Hydrogen ion excretion of renal tubule examination showed that the hydrogen ion excretion was intended to normal in rejection prophase patients. The hydrogen ion excretion of renal tubule was significantly decreased in the rejection phase patients, compared with those in the rejection prophase patients and patients of stabilization group (P ＜ 0.01 ). The hydrogen ion excretion of renal tubule was recovered rapidly in the most acute rejective patients after treatment. The recovery of hydrogen ion excretion of renal tubule was various. The recovery time of most cases ranged from 1-10 weeks with an average of about 6 weeks, 2 cases did not recover in 10 weeks and 3 cases of 4 severe rejection cases had slow recovery after treatment.CONCLUSION : Hydrogen ion excretion of renal tubule can bridge the gap of bad reflection of renal tubule function from serum creatinine (Scr) and can diagnose the acute rejection after renal transplantation in continuous observation, and especially can be as a valuable index to assess curative effect and prognosis of rejection treatment.
