CAJ | 학술논문

背景：慢性移植物肾病是肾移植领域较难处理的一种临床并发症，大多数最终会发展为移植肾失功。骨髓间充质干细胞作为一种低免疫原性的特殊细胞群，已证实具有分化、转分化、旁分泌等多种功能，在临床其他领域已有成功应用的基础。基于此特点，将其应用于慢性移植物肾病的患者可能会起到一定的治疗作用。目的：探讨数字减影动脉造影引导下经移植肾动脉输注及之后经静脉输注自身骨髓间充质干细胞治疗慢性移植物肾病的安全性与可行性。方法：选择2011年3月至2013年1月间确诊慢性移植物肾病且符合入组标准的患者11例，行1次数字减影动脉造影引导下经移植肾动脉输注及之后2次经静脉输注骨髓间充质干细胞。观察治疗后1年内患者血肌酐、尿素氮、内生肌酐清除率、胱抑素C、24 h尿蛋白、血/尿β2微球蛋白的变化情况。结果与结论：11例患者未发生出血、移植肾动脉栓塞、假性动脉瘤等相关并发症。骨髓间充质干细胞治疗后1周、1个月时血肌酐、尿素氮、胱抑素C水平与治疗前相比明显下降，其差异有显著性意义(P<0.05)；治疗3个月后，各指标与治疗前比较差异无显著性意义(P>0.05)。骨髓间充质干细胞治疗后1周、1个月时内生肌酐清除率较治疗前升高，其差异有显著性意义(P<0.05)；而治疗3个月后与治疗前比较差异无显著性意义(P>0.05)。治疗7 d时24 h尿蛋白水平与治疗前相比明显下降，其差异有显著性意义(P<0.05)，而治疗1个月后差异无显著性意义(P>0.05)；血/尿β2微球蛋白治疗前后均无明显变化。结果可见数字减影动脉造影引导下经移植肾动脉输注及经静脉输注骨髓间充质干细胞治疗慢性移植物肾病是安全的，对患者肾功能改善有一定效果，输注细胞剂量及后续输注方式的选择尚有待研究。
배경：만성이식물신병시신이식영역교난처리적일충림상병발증，대다수최종회발전위이식신실공。골수간충질간세포작위일충저면역원성적특수세포군，이증실구유분화、전분화、방분비등다충공능，재림상기타영역이유성공응용적기출。기우차특점，장기응용우만성이식물신병적환자가능회기도일정적치료작용。목적：탐토수자감영동맥조영인도하경이식신동맥수주급지후경정맥수주자신골수간충질간세포치료만성이식물신병적안전성여가행성。방법：선택2011년3월지2013년1월간학진만성이식물신병차부합입조표준적환자11례，행1차수자감영동맥조영인도하경이식신동맥수주급지후2차경정맥수주골수간충질간세포。관찰치료후1년내환자혈기항、뇨소담、내생기항청제솔、광억소C、24 h뇨단백、혈/뇨β2미구단백적변화정황。결과여결론：11례환자미발생출혈、이식신동맥전새、가성동맥류등상관병발증。골수간충질간세포치료후1주、1개월시혈기항、뇨소담、광억소C수평여치료전상비명현하강，기차이유현저성의의(P<0.05)；치료3개월후，각지표여치료전비교차이무현저성의의(P>0.05)。골수간충질간세포치료후1주、1개월시내생기항청제솔교치료전승고，기차이유현저성의의(P<0.05)；이치료3개월후여치료전비교차이무현저성의의(P>0.05)。치료7 d시24 h뇨단백수평여치료전상비명현하강，기차이유현저성의의(P<0.05)，이치료1개월후차이무현저성의의(P>0.05)；혈/뇨β2미구단백치료전후균무명현변화。결과가견수자감영동맥조영인도하경이식신동맥수주급경정맥수주골수간충질간세포치료만성이식물신병시안전적，대환자신공능개선유일정효과，수주세포제량급후속수주방식적선택상유대연구。
BACKGROUND:Chronic al ograft nephropathy is a complication of kidney transplantation and most of patients wil eventual y develop transplant kidney dysfunction. Bone marrow mesenchymal stem cells as a low immunogenicity special cellpopulation have been shown to have differentiation, transdifferentiation, paracrine and other basic functions, which have been successful used in other clinical areas. Based on this characteristic, bone marrow mesenchymal stem cells may play a therapeutic role in chronic al ograft nephropathy. OBJECTIVE:To study the safety and feasibility of autologus bone marrow mesenchymal stem cells transplantation via renal artery infusion and subsequent intravenous infusion guided by the digital subtraction angiography in the treatment of chronic al ograft nephropathy. METHODS:Eleven patients with chronic al ograft nephropathy who were confirmed from March 2011 to January 2013 were enrol ed, and then received transplant renal artery infusion once guided by the digital subtraction angiography and subsequent intravenous infusion twice of bone marrow mesechymal stem cells. Changes in serum creatinine, blood urea nitrogen, creatinine clearance, cystatin C, 24-hour urine protein, andβ2 microglobulin in the blood and urinary were monitored in patients up to 1 year after treatment. RESULTS AND CONCLUSION:Bleeding, transplant renal artery embolization, pseudoaneurysm and other related complications were not found in any of the 11 patients. The levels of serum creatinine, blood urea nitrogen and cystatin C were significantly decreased at 1 week and 1 month after celltherapy (P<0.05), while after 3 months of treatment, there was no difference before and after treatment (P>0.05). The creatinine clearance at 1 week and 1 month after treatment showed a remarkable increase, which were significantly different from that before treatment (P<0.05), but after 3 months of treatment, the difference was not significant (P>0.05). The level of 24-hour urine protein was significantly decreased after 7 days of treatment (P<0.05), and no difference was found after 1 month (P>0.05). The level ofβ2 microglobulin in the blood and urinary had no changes before and after treatment. These findings indicate that guided by the digital subtraction angiography, bone marrow mesenchymal stem cells via the renal artery infusion and subsequent intravenous infusion can improve kidney function of patients, but the celldosage and infusion method remain to be solved.