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目的:观察中国肾移植受者移植肾组织肾小管周围毛细血管 (PTC)C4d阳性的急性排斥反应 (AR)患者的临床过程及其转归,为此类患者的救治提供借鉴。 方法:1999年 4月~2004年 6月间发生AR的肾移植受者,利用间接免疫荧光法检测移植肾组织C4d的沉积,对阳性者观察临床、病理特点、治疗反应以及临床转归。 结果:21例C4d阳性AR患者,主要发生在年轻男性(33 5±7 2岁)与中年女性 (40. 9±6 .7岁 )中; 7例术前群体反应性抗体(PRA)高, 66 .7%的AR发生在术后 2周内(14 /21), 6个月后仍然有 3例发生,其中 2例与免疫抑制剂的撤换有关; 62%的患者需透析治疗,仅 4例对冲击治疗有反应, 4例接受免疫吸附联合FK506 +霉酚酸酯(MMF)治疗者有 3例完全逆转, 1例移植肾丢失, 1例受者主要因消化道反应未能成功切换FK506而单独应用IA,最终未能逆转; 12例单纯应用FK506+MMF治疗者(1例加用抗胸腺球蛋白 )有 6例完全逆转, 4例部分缓解。所有需要透析的患者均接受连续性血液净化(CBP)治疗, 1例单独应用长时间CBP治疗的受者也成功逆转。患者性别和发生AR的时间与移植肾转归有关,后期发生的AR以及女性受者预后较差。 结论:C4d阳性的AR多发生在术后早期;传统上的AR高危人群发生率高,晚期也可发生,但预后较差;组织学上多伴PTC部位中性粒?
OBJECTIVE: To observe the clinical course and prognosis of acute rejection (AR) patients with C4d-positive peripheral tubules (PTC) in renal allograft recipients in China and provide references for the treatment of these patients. Methods: Renal transplant recipients with AR were recruited from April 1999 to June 2004. The deposition of C4d in renal allograft tissues was detected by indirect immunofluorescence. The clinical, pathological features, therapeutic response and clinical outcome were observed. Results: Twenty-one patients with C4d-positive AR mainly occurred in young men (33 5 ± 7 2 years) and middle-aged women (40.9 ± 6 .7 years). Preoperative 7 patients had high PRA , 66.7% of AR occurred within 2 weeks after operation (14/21), and 3 cases still occurred after 6 months, of which 2 cases were related to the replacement of immunosuppressive agents; 62% required dialysis treatment and only 4 patients responded to shock therapy, 4 patients received immunosuppression combined with FK506 + mycophenolate mofetil (MMF), 3 patients completely reversed, 1 patient lost renal graft, 1 patient failed to switch due to gastrointestinal reaction FK506 and IA alone, and ultimately failed to reverse; 12 cases of pure FK506 + MMF treatment (1 case of anti-thymus globulin) were completely reversed in 6 cases, 4 cases partially relieved. All patients in need of dialysis underwent continuous blood purification (CBP), and 1 patient who had been treated with long-term CBP alone also reversed successfully. The patient’s gender and the time at which AR occurred were related to the allograft outcome and the later AR and female recipients had a poor prognosis. Conclusion: C4d-positive AR occurred in early postoperative; the high incidence of AR in the traditional high risk group, but also can occur late, but the prognosis is poor; histologically more with PTC site neutrophil?