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目的:回顾性分析抗中性粒细胞胞质抗体(ANCA)相关肾炎(AAGN)患者接受肾移植后的转归。方法:11例AAGN患者[男4例,女7例,中位年龄48(33.5~52.5)岁]接受肾移植。采用激素、吗替麦考酚酯联合他克莫司/环孢素A三联抗排斥治疗。肾移植后排斥反应及其类型均经移植肾活检病理诊断。回顾性分析移植肾预后、血管炎复发及血清ANCA对移植肾预后的影响。结果:11例AAGN均为MPO-ANCA相关血管炎,10例在肾移植前接受肾脏替代治疗,中位时间为30.5(14.8~50.5)个月。肾移植前均无血管炎活动(BVAS 0分),7例血清MPO-ANCA阳性。肾移植术后均未出现移植肾功能延迟恢复,4例(36.4%)发生急性细胞性排斥反应,分别有1例术后18个月和22个月发生血管炎复发和慢性体液性排斥反应。术后中位随访56(46.5~135)个月,随访末8例(72.7%)血清肌酐水平正常,2例血清肌酐升高,1例移植肾失功。5年人、肾生存率分别为100%和90.9%。术前ANCA阳性与阴性患者比较移植肾排斥反应发生率和血管炎复发率均无显著差异。结论:AAGN患者肾脏移植后远期预后好,血管炎复发率低,但术后早期急性排斥反应发生率高,应加强预防抗排斥反应。
OBJECTIVE: To retrospectively analyze the outcome of renal transplant recipients with anti-neutrophil cytoplasmic antibody (ANCA)-associated nephritis (AAGN). METHODS: Eleven patients with AAGN [4 males and 7 females with a median age of 48 (33.5-52.5) years) underwent kidney transplantation. With hormones, mycophenolate mofetil combined with tacrolimus / cyclosporin A triple anti-rejection therapy. Rejection after renal transplantation and its type are all confirmed by pathological examination of the renal biopsy. Retrospective analysis of the prognosis of renal allograft, the recurrence of vasculitis and serum ANCA on the prognosis of renal allograft. Results: Eleven patients with AAGN were MPO-ANCA-associated vasculitis. Ten patients underwent renal replacement therapy prior to renal transplantation. The median time was 30.5 (14.8-50.5) months. Vasculitis activity (BVAS score 0) before renal transplantation, MPO-ANCA positive in 7 patients. Delayed recovery of graft function did not occur after renal transplantation. Acute cell rejection occurred in 4 cases (36.4%). One case had vasculitis relapse and chronic body fluid rejection at 18 months and 22 months respectively. After a median follow-up of 56 (46.5-135) months, serum creatinine level was normal in 8 cases (72.7%) at the end of follow-up, serum creatinine increased in 2 cases, and graft failure occurred in 1 case. 5 years, kidney survival rates were 100% and 90.9%. Preoperative ANCA positive and negative patients compared graft rejection and vasculitis recurrence rate was no significant difference. CONCLUSION: The long-term prognosis of AAGN patients after kidney transplantation is good, and the recurrence rate of vasculitis is low. However, the incidence of acute rejection in early stage after AAGN is high, and anti-rejection should be strengthened.