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目的 探讨移植肾早期（７ ｄ内）血管性排斥的治疗措施。方法 根据 Ｂａｎｆｆ ９７病理分类法诊断排斥，Ⅲ型排斥８例，Ⅱ型排斥２９例。采用双滤过法血浆分离术（ＤＦＰＰ）、抗淋巴细胞球蛋白（ＡＴＧ或 ＯＫＴ３）、骁悉和大剂量百令胶囊综合抗排斥治疗 ３１例（治疗组）；采用激素冲击和 ＡＴＧ或ＯＫＴ３治疗６例（对照组）。结果 治疗组２８例（９０．３％）排斥逆转，对照组仅１例（１６．７％）排斥逆转。两组移植肾严重破裂发生率分别为治疗组２２．６％（７／２９），对照组５０％（３／６），保肾成功率分别为７１．４％和零；感染发生率治疗组为２２．６％，对照组为８３．３％。病死率治疗组为９．７％，对照组为１６．７％。治疗组移植肾１年存活率７９．３％。结论 以ＤＦＰＰ为主的综合抗排斥措施显著提高了早期移植肾血管性排斥的临床疗效和移植肾近期存活率。
Objective To investigate the treatment of vascular rejection in early stage of renal transplantation (within 7 days). Methods According to the pathological classification of Banff 97, 8 cases of type Ⅲ rejection and 29 cases of type Ⅱ rejection were diagnosed. Thirty-one patients (treatment group) were treated with double-filtration plasmapheresis (DFPP), anti-lymphocyte globulin (ATG or OKT3), definitive and high-dose Bailing capsules. Antihypertensive therapy and ATG or OKT3 6 cases (control group). Results In the treatment group, 28 cases (90.3%) were rejected and only 1 case (16.7%) in the control group were excluded. The incidences of severe renal allograft rupture in two groups were 22.6% (7/29) in the treatment group and 50% (3/6) in the control group, respectively, and the success rates of kidney-preservation were 71.4% and 0% respectively. The incidence of infection in the treatment group 22.6% in the control group and 83.3% in the control group. The case fatality rate was 9.7% in the treatment group and 16.7% in the control group. The 1-year survival rate of the treated group was 79.3%. Conclusion The comprehensive anti-rejection strategy based on DFPP significantly improves the curative effect of early rejection of renal allografts and the survival rate of renal allografts.