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背景:移植后的急性排斥是肾移植术后的主要并发症,也是导致慢性排斥反应和移植物失功最重要的危险因素,因此,了解肾小管泌氢功能能否早期反映移植物的功能情况有重要意义。目的:观察肾移植患者术后肾小管泌氢功能,并进行监测,探讨其在移植物急慢性排斥中的作用。设计:病例-对照观察。单位:解放军济南军区总医院泌尿外科。对象:选择2000-05/2005-06解放军济南军区总医院泌尿外科连续实施肾脏移植26例患者,男16例,女10例;年龄21～58岁,平均35岁。原发病均为慢性肾小球肾炎,慢性肾功能衰竭,全部为尸肾移植。供受者均血型相同、淋巴细胞毒试验阴性。其中1例为第2次移植。所有患者对检测项目知情同意。方法:依据典型的临床表现,彩色多普勒超声及血流变化诊断患者排斥反应,16例患者未发生排斥反应为稳定组,10例发生排斥反应的患者为排斥组,排斥组根据排斥情况分为排斥前期、排斥期及恢复期。对所有患者术前及术后1周起每周1次,连续10周分别以化学清洁玻璃瓶留取晨起中段尿测定尿可滴定酸、NH4+和净酸水平评估肾小管泌氢功能。主要观察指标:两组患者尿可滴定酸、NH4+和净酸水平。结果:纳入患者26例均进入结果分析。排斥反应组排斥前期患者肾小管泌氢功能各检测值显示泌氢功能开始建立,并趋向正常,排斥期患者肾小管泌氢功能检测值均显示明显下降,与排斥前期及稳定组比较均有统计学显著性差异(P<0.01)。恢复期患者排斥反应治疗后监测的结果显示泌氢功能恢复较快。肾小管泌氢功能总体连续观察结果显示总体恢复的不均衡性,大部分病例恢复时间从1～10周不等,平均恢复期限约6周,2例10周内未恢复,4例严重排斥者中3例治疗后泌氢功能恢复缓慢。结论:肾小管泌氢功能可弥补血清肌酐不能良好反映肾小管功能的不足,能在连续观察中对移植肾急性排斥反应的诊断,特别是对抗排斥治疗的效果判断和预后评估中作为有价值的指标。
BACKGROUND: Acute rejection after transplantation is a major complication after renal transplantation. It is also the most important risk factor leading to chronic rejection and graft failure. Therefore, to understand whether renal tubular secretion of hydrogen can early reflect the function of graft There’s important meaning. OBJECTIVE: To observe the postoperative renal tubular secretion of hydrogen in renal transplant recipients and to monitor its role in acute and chronic graft rejection. Design: Case-control observation. Unit: Jinan Military Region General Hospital of Urology. PARTICIPANTS: Select 26 patients with renal transplantation consecutively from Department of Urology, Jinan Military Region General Hospital of PLA from May 2000 to June 2005, 16 males and 10 females; aged 21 to 58 years with an average of 35 years. Primary disease are chronic glomerulonephritis, chronic renal failure, all for the autologous kidney transplantation. The recipients were the same blood type, negative lymphocytic toxicity test. One case was the second transplant. All patients informed consent of test items. Methods: According to the typical clinical manifestations, color Doppler ultrasound and blood flow changes in the diagnosis of rejection, 16 patients without rejection was stable group, 10 patients with rejection reaction rejection group, rejection group according to the exclusion To exclude the early rejection and recovery period. All patients were evaluated preoperatively and once a week from week 1, week 10 for 10 consecutive weeks with chemical clean glass bottles for determination of urinary titratable acid, NH4 +, and neuraminidase in the middle of early morning urine to evaluate renal tubular hydrogen production. MAIN OUTCOME MEASURES: Urinary titratable acid, NH4 +, and net acid levels were compared between two groups. Results: Twenty-six patients were included in the result analysis. The exclusion reaction group exclusion of renal tubular secretion of hydrogen test results showed that the beginning of the establishment of hydrogen secretion function, and to normal, renal rejection in patients with renal tubular secretion test showed a significant decrease, compared with the pre-rejection and stable group were statistically There was significant difference (P <0.01). Survival patients with rejection after treatment monitoring results show that the recovery of hydrogen function faster. The overall continuous renal tubular secretion of hydrogen showed that the overall recovery of the imbalance in most cases recovery time ranging from 1 to 10 weeks, the average recovery period of about 6 weeks, 2 cases did not recover within 10 weeks, 4 cases of severe rejection In 3 cases, the recovery of hydrogen production was slow. CONCLUSION: The function of renal tubular secretion of hydrogen can make up for the deficiency of serum creatinine which can not well reflect the function of renal tubules. It can be used as a valuable tool in the diagnosis of acute renal allograft rejection, especially in the judgment and prognosis of rejection therapy index.