CAJ | 학술논문

目的探讨血浆置换治疗肾移植术后抗体介导的急性排斥反应的效果. 方法 2011年1月至2013年9月行同种异体肾移植术后发生抗体介导的急性排斥反应患者5例,男2例,女3例.年龄41252岁,平均46岁.术前诊断均为慢性肾功能不全尿毒症期,行规律血液透析.术后采用环孢素[5 mg/(kg·d)]或他克莫司[0.1 mg/(kg·d)],以及吗替麦考酚酯(1.5 g/d)和糖皮质激素行免疫抑制治疗.术后2周内均经移植肾穿刺病理检查及血清供者特异性抗体测定诊断为抗体介导的急性排斥反应.予甲泼尼龙(1 000 mg/d)和抗淋巴细胞球蛋白(250 mg/d)治疗无效,在环孢素[5 mg/(kg·d)]或他克莫司[0.1 mg/(kg·d)],以及吗替麦考酚酯(1.5 g/d)和糖皮质激素免疫抑制治疗的基础上,5例患者均分别行血浆置换7次.4例原发病为慢性肾小球肾炎,术前血清肌酐为(784±154) μmol/L,术后2周内开始进行血浆置换;1例原发病为抗肾小球基底膜肾病,术前血清肌酐水平为935 μmol/L,术后35 d开始进行血浆置换. 结果 4例原发病为慢性肾小球肾炎患者分别经7次血浆置换治疗后排斥反应得到逆转,肾功能恢复良好,随访3个月时血清肌酐水平为(113±12) μmol/L.原发病为抗肾小球基底膜肾病患者,血浆置换后排斥反应未得到纠正,移植肾功能未恢复,随访3个月时血清肌酐水平524 μmol/L,继续血液透析治疗,随访12个月时血清肌酐水平758 μmol/L,超声检查示移植肾萎缩,予口服他克莫司0.5mg/d治疗. 结论 2周内应用血浆置换能有效地逆转肾移植术后患者抗体介导的急性排斥反应.
목적 탐토혈장치환치료신이식술후항체개도적급성배척반응적효과. 방법 2011년1월지2013년9월행동충이체신이식술후발생항체개도적급성배척반응환자5례,남2례,녀3례.년령41252세,평균46세.술전진단균위만성신공능불전뇨독증기,행규률혈액투석.술후채용배포소[5 mg/(kg·d)]혹타극막사[0.1 mg/(kg·d)],이급마체맥고분지(1.5 g/d)화당피질격소행면역억제치료.술후2주내균경이식신천자병리검사급혈청공자특이성항체측정진단위항체개도적급성배척반응.여갑발니룡(1 000 mg/d)화항림파세포구단백(250 mg/d)치료무효,재배포소[5 mg/(kg·d)]혹타극막사[0.1 mg/(kg·d)],이급마체맥고분지(1.5 g/d)화당피질격소면역억제치료적기출상,5례환자균분별행혈장치환7차.4례원발병위만성신소구신염,술전혈청기항위(784±154) μmol/L,술후2주내개시진행혈장치환;1례원발병위항신소구기저막신병,술전혈청기항수평위935 μmol/L,술후35 d개시진행혈장치환. 결과 4례원발병위만성신소구신염환자분별경7차혈장치환치료후배척반응득도역전,신공능회복량호,수방3개월시혈청기항수평위(113±12) μmol/L.원발병위항신소구기저막신병환자,혈장치환후배척반응미득도규정,이식신공능미회복,수방3개월시혈청기항수평524 μmol/L,계속혈액투석치료,수방12개월시혈청기항수평758 μmol/L,초성검사시이식신위축,여구복타극막사0.5mg/d치료. 결론 2주내응용혈장치환능유효지역전신이식술후환자항체개도적급성배척반응.
Objective To investigate the efficacy of plasmapheresis therapy for treating the antibody-mediated acute rejection (AMR) after kidney transplantation.Methods The study group consists of 2 male patients and 3 female patients,who suffered with AMR after receiving first-time allograft renal transplantation from January 2011 to September 2013 in our hospital.The age ranged from 41 to 52 years old,average 46 years old.The preoperative diagnosis in all patients was chronic renal insufficiency (uremia stage) and the regular hemodialysis was given to them.The 5 patients received basic immunosuppressive therapy,including cyclosporine A [5 mg/(kg · d)] or FKS06 [0.1 mg/(kg · d)],mycophenolate mofetil (MMF) (1.5 g/d) and steroids.All the antibody-mediated acute rejections were diagnosed by renal allograft biopsy and serum DSA determination within 2 weeks after transplantation.Seven cycles of plasmapheresis rescue therapy were given to those patients respectively after the failure therapy of high dose of corticosteroids (1 000 mg/d) and ALG (250 mg/d).4 cases with primary glomerulonephritis,whose preoperative serum creatinine level was (784± 154) μ mol/L,were given plasmapheresis therapy within 2 weeks after transplantation.One case with primary anti-glomerular basement membrane disease,whose preoperative serum creatinine level was 935 μmol/L,received plasmapheresis 35 d after transplantation.The serum DSA in all patients was positive before plasmapheresis.Results After 7 cycles of plasmapheresis rescue therapy,the AMR was reversed in four 4 cases,whose plasmapheresis was given within 2 weeks after transplantation.Within three months follow-up,their renal function recovered well,which the mean serum creatinine level was (113± 12) μmol/L.In the case,whose plasmapheresis was given 35 days after transplantation,rejection was not reversed.His serum creatinine was 524 μmol/L and the intermittent hemodialysis was given,subsequently.With a follow-up of 12 months,the ultrasound examination showed that the atrophy of transplanted kidney and a high level of serum creatinine (758 μmol/L).Low dose of FK506 (0.5 mg/d) was given based on those results.Conclusions Active application of plasmapheresis can effectively reverse antibodymediated acute rejection within two weeks after transplantation.