目的 探讨肾移植受者围术期血红细胞免疫功能及CD4、CD8淋巴细胞的变化.方法 选取2013年1月-2017年3月肾移植受者25例,25例健康体检者作为对照组,分别于术后3d、7d、14d、1个月、3个月采集外周血行红细胞免疫功能和CD4、CD8淋巴细胞数检测,观察红细胞免疫功能和淋巴细胞数的变化情况.结果 肾移植受者术前红细胞花环率低于对照组,其表面膜分子CD35、CD58、CD59表达也低于对照组,而CD4、CD8淋巴细胞数稍低于对照组,术后红细胞花环率、CD4、CD8淋巴细胞数呈现先下降后逐步恢复的过程,其表面膜分子CD35于术后呈现先降后升现象,CD58、CD59于术后呈现先轻微上升,后逐步恢复.结论 肾移植受者术前红细胞免疫功能低于对照组,术后有所改善,其变化与淋巴细胞变化基本一致,红细胞免疫可能参与到淋巴细胞及肾移植受者机体免疫功能的调节.

目的 探讨肾移植术后采用无肾上腺皮质激素(激素)免疫抑制方案的临床疗效及安全性.方法 选择肾移植术后1年以上采用无激素免疫抑制方案的55例肾移植受者为激素早期撤除组,另选择同期60例常规使用激素免疫抑制方案的肾移植受者作为对照组.记录肾移植1年内2组肾移植受者的血糖、血脂变化以及术后感染、急性排斥反应(AR)发生情况,比较2组在肾移植术后1年的肾功能指标,对患者进行定期随访,观察术后2组肾移植受者及移植肾的存活情况.结果 肾移植术后1年,激素早期撤除组肾移植受者的血糖、血脂水平及肺部感染发生率均低于对照组(P均<0.05),其尿蛋白水平高于对照组(P<0.001).2组的血清肌酐、血尿素氮水平相近(P均>0.05),组间AR、心血管疾病、泌尿系统感染、消化系统感染及神经系统感染发生率比较差异亦无统计学意义(P均>0.05).2组肾移植受者及移植肾的生存曲线比较差异均无统计学意义(P均>0.05).结论 肾移植术后早期撤除激素的免疫抑制方案不增加肾移植受者术后AR的发生率,使用该方案的肾移植受者血糖、血脂均优于常规使用激素免疫抑制方案,且采用2种免疫抑制治疗方案的肾移植受者及移植肾存活率相近.

Objective To observe the early clinical effect of single kidney transplantation from cardiac death pediatric donors to adult recipients. Methods Clinical data of 6 single kidney transplantations from cardiac death pediatric donors in adult recipients in Department of Organ Transplantation ,Guangdong Province No.2 People′s hospital were retrospectively analyzed. the transplant operations were carried out between January 2010 to may 2016.The median age of 6 pediatric donors was 9 years (5 years to 15 years). All recipients had the same blood type. The median age of 12 recipients was 38 years (21 years to 65 years),with 4 man and 8 women. All recipients received kidney transplantation for the first time,and overall reactive antibodies(PRA) were negative,with HLA mismatch between 1to 4. All recipients received single kidney transplantation in right fossa iliaca. Results 12 kidney transplantations were successful. The renal allografts recovered successfully without acute renal rejection , delayed graft function or primary nonfunction. Renal function of 5 of recipients immediately recovered in 5 days,5 recovered in 10 days,and 2 recovered slowly. 1 recipient manifested urine leak and recovered after drainage. 1 case developed delayed incision healing and recovered after dressing at stage II. All patients and renal grafts functions were wellnormal during follow?up period between 1 month to 36 months. Conclusion The early clinical effect of single kidney transplantation from cardiac death pediatric donors to adult recipients is good and could be a promising pathway to expand the organ donor sources.

Objective To observe the interaction of tacrolimus(FK‐506) and ertapenem after simultaneously taking in renal transplant recipients of Guangdong region .Methods Twelve renal transplant recipients in our hospital during 2013 were retrospectively evaluated .The blood drug concentrations of tacrolimus and ertapenem were detected by using the automatic chemoluminescence immunoassay .Results The blood concentration of tacrolimus on 3 d after taking was increased from(7 .5 ± 0 .34)ng/mL to(13 .8 ± 0 .25)ng/mL(P< 0 .05) .The fraction derived from the drug interaction potential scale indicated that certain mechanism of interaction action and influence of ertapenem and ta‐crolimus existed in the patient′s body .Conclusion In simultaneously using tacrolimus (FK‐506) and ertapenem for kidney transplant patients ,the tacrolimus dose should be timely adjusted for preventing the drug poisoning .

目的:探讨肾移植术后中远期出血的特点和诊治方法。方法:回顾6例术后并发血管疾病的肾移植患者临床资料,对其发病特点和诊治方法进行分析总结。结果:6例患者中,并发移植肾破裂2例,移植肾动脉破裂出血3例,移植肾动脉破裂伴瘤样动静脉内瘘形成1例。6例均经彩色多普勒血流显像(CDFI)作出诊断,其中2例经CT明确诊断,3例进一步行磁共振血管成像明确诊断,1例经血管造影进一步明确诊断。所有患者经手术治疗,2例移植肾破裂,1例修补成功,1例行移植肾切除;3例移植肾动脉破裂均行移植肾切除;1例移植肾动脉破裂伴瘤样动静脉内瘘形成患者经血管修补整形成功。结论:肾移植术后的出血发展迅速,应根据具体情况及时采取相应治疗手段,处理不及时往往导致严重后果,因此早期诊断非常重要,CDFI可作为首选筛查手段。

Objective To investigate the clinical effect of Huangkui Capsule combined with Losartan in treating proteinuria after renal transplantation.Methods 80 patients who accepted cadaveric renal transplantation more than six months and whose urinary protein ≥300 mg were randomly divided into treatment group(40 cases) and control group(40 cases).Treatment group was given 5 pills of Huangkui Capsules,3 times a day and Losartan 50 mg,once a day.While control group was given only Losartan 50 mg,once a day.The course of treatment was 8 weeks.24 h urinary protein,albumin,renal function,levels were measured before and after treatment,differences within groups and between groups were compared and clinical effect were evaluated.Results The total effective rate of treatment group was better than control group,there were statistically significant differences(P < 0.05);after 8 weeks,urinary albumin and serum albumin in treatment group dropped significantly,there were statistically significant differences(P < 0.05) when compared with control group.All results measured in different time within treatment group were statistically significant different(all P < 0.05).Conclusion It is safe and effective of the combined treatment of Huangkui Capsule and Losartan in proteinuria after renal transplantation and worthy of clinical use.

目的探讨肾移植术后安全有效雷帕霉素应用的成本-效果。方法回顾性分析178例首次肾移植患者资料,雷帕霉素组72例:雷帕霉素联合他克莫司和醋酸泼尼松,移植后即开始服用雷帕霉素,首次负荷剂量为6 mg/d,维持剂量为1～2 mg/d。对照组106例:吗替麦考酚酯联合他克莫司和醋酸泼尼松。采用吖啶酯化学发光法(雅培i1000SR机器)测定雷帕霉素C0,根据排斥发生率判断雷帕霉素安全有效C0范围,应用药物经济学成本-效果法评价雷帕霉素治疗方案。结果雷帕霉素组患者雷帕霉素总的全血C0为(6.6±2.5)μg/L,10及90百分位数浓度分别为3.38μg/L和11.36μg/L。6个月内雷帕霉素组急性排斥发生率为16.7%(12/72),对照组为17.0%(18/106),有效率分别为83.3%和83.0%,两组急性排斥发生率和治疗有效率比较差异无统计学意义(P>0.05),终点血肌酐雷帕霉素组(117±38)μmol/L,对照组(125±20)μmol/L,差异无统计学意义(P>0.05),两组不良反应情况比较雷帕霉素组仅高脂血症发生率明显高于对照组(P<0.05)。两组方案应用每个月总成本雷帕霉素组为(7 088±450)元,对照组为(7 268±432)元,两组成本-效果比雷帕霉素组为510,对照组为525,两组差异无统计学意义(P>0.05)。结论建议采用雷帕霉素方案时C0维持在(6.6±2.5)μg/L为安全有效范围,可依据患者自身情况选择雷帕霉素联合他克莫司、醋酸泼尼松的长期治疗方案。

Objective To investigate the changes of panel reaction antibody (PRA) and the effects of HLA sensitized paths in patients waiting for renal transplantation.Methods PRA of 10 555 samples from 8926 renal transplant recipients in 51 transplant centers was analyzed.In 1991-1998 group,PRA was by using NIH-CDC technique,and in 1999-2010 group,PRA was detected by using ELISA.The effects of blood transfusion,pregnancy and transplantation on the PRA positive rate were analyzed.Results There were 1324 recipients positive for PRA in 8926 (14.83 ％ ).The average PRA positive rate in 1991 1998 group and 1999-2010 group was 18.17％ (513/2823) and 13.29％ (811/6103) repectively (P＜0.01).Among 1324 PRA positive recipients,the number of recipients with PRA of 1％-30％ and PRA of ≥30％ respectively accounted for 71.83％ and 28.17％.There were statistically significant differences in the PRA positive rate between the recipients receiving blood transfusion and those without blood transfusion (31.77％ vs 1.21％,P ＜ 0.01 ),between the recipients having pregnancy history and those without pregnancy history (24.64％ vs 7.19％,P＜ 0.01 ),and between primary transplant and re-transplant recipients (13.35 ％ vs 40.62％,P＜0.01).Conclusion In last 20 years, PRA in majority of PRA positive recipients was ＜ 30％ (low sensitized).Renal transplantation and blood transfusion were the important influencing factors that led to positive PRA,and pregnancy history was a related factor.

目的探讨乙肝病毒携带者肾移植术后的监测方案及处理。方法 15例患者中,6例乙型肝炎表面抗原(HBsAg)阳性,e-抗原(HBeAg)及核心抗体(HBcAb)阴性,3例HBsAg、HBeAg及HBcAb阳性,6例HBsAg、HBeAb及HBcAb阳性。所有患者乙肝病毒DNA(HBV-DNA)均为阴性,术后常规服用免疫抑制剂(CSA+MMF+PRED或FK506+MMF+PRED)和拉米夫定。并定期行肝、肾功能复查,如检查显示肝功能异常,则复查HBV-DNA。结果术后随访12～36个月,9例患者于术后2周内出现程度不同的肝功能异常,以丙氨酸氨基转移酶和天冬氨酸氨基转移酶升高为主,HBV-DNA检测呈阴性,经调整免疫抑制剂用量,并给予护肝治疗,患者的肝功能恢复正常。3例HBsAg、HBeAg、HBcAb阳性患者,术后4～6个月出现肝功能异常,复查HBV-DNA阳性,将拉米夫定调整为恩替卡韦,同时给予还原型谷胱甘肽和腺苷蛋氨酸静脉滴注,患者肝功能逐步恢复正常,其HBV-DNA定量于服药后2～3个月转阴。继续给予恩替卡韦口服。1例HBsAg、HBeAg、HBcAb阳性患者,术后服用拉米夫定4个月,未测HBV-DNA定量,未经医生同意自行停用拉米夫定,于19个月复查时发现转氨酶及胆红素均明显升高,复查HBV-DNA>105拷贝/mL,给予抗病毒、护肝、对症治疗效果欠佳,于20个月时出现黄疸、腹水、肝功能衰竭,终因抢救无效死亡。结论乙肝病毒携带者肾移植术后,有部分患者会出现肝功能异常、HBV-DNA转阳,因此应定期监测肝功能及HBV-DNA,如肝功能异常,应正确区分是病毒性肝损害还是药物性肝损害,如HBV-DNA转阳,及时调整抗病毒药同时行护肝治疗。以促进肝功能恢复正常。

肾缺血再灌注损伤(renal ischemic reperfusion injure, RIRI)见于许多临床病理和肾脏手术过程,为肾移植、休克肾、肾部分切除、肾盂积水、选择性尿道手术等常见并发症.

OBJECTIVE To construct a function model that can be used in the diagnosis bladder outlet obstruction (BOO) resulting from benign prostatic hyperplasia, and to develop a diagram allowing the judgement of bladder outlet for patients with different detrusor contractility, especially with impaired one. METHODS Urodynamic and clinical data of 131 men were analyzed retrospectively. By Logistic analysis, a function model was constructed. Based on the model, a diagram allowing the evaluation of bladder outlet was drawn. The cutoff point for diagnosing BOO with the function model and the curve was confirmed by ROC curve analysis. RESULTS The function model (BOOI) was obtained by the formula 5.03 x residual fraction + 0.04 x PdetatQmax - 0.20 x Qmax - 0.91 + alpha (alpha = 0 for those with low pressure-low flow on P-FS, alpha = 1.42 for high pressure-low flow, alpha = -7.30 for high pressure-high flow). The cutoff point for BOOI diagnosing BOO was 0.36. When validated, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.7%, 91.7%, 96.0% and 73.3% respectively. CONCLUSION The BOOI, with an easy calculation mode, could predict the probability of BOO. The sensitivity and specificity of the criterion for the diagnosis of BOO were satisfactory. The curve we drew could help to differentiate the obstructed men with low pressure-low flow and thus benefit them by surgical relief of their obstruction.

目的:探讨抗HLA抗体及其特异性与慢性移植肾肾病(CAN)的关系.方法:移植肾穿刺活检确诊(依照Banff97标准)为CAN的36例患者设为病例组,随机抽取门诊随访的106例移植肾功能稳定受者设为对照组,酶联免疫方法(ELISA)检测术前、术后抗HLA抗体及其特异性,回顾性分析比较两组术前及术后抗HLA抗体及其特异性.结果:①两组术前抗HLA抗体阳性率无显著性差异(19.4% vs 18.9%,P＝0.939),CAN组术前抗HLA抗体阴性术后转为阳性比率明显高于对照组(51.7% vs 16.3%,P<0.001),CAN组术后抗HLA抗体阳性率明显高于对照组(58.3% vs 20.1%,P<0.001).②术后 CAN组抗HLA Ⅱ类抗体阳性率明显高于对照组(76% vs 36%,P=0.009),抗体特异性分布在两组之间有显著性差异(P＝0.027).结论:抗HLA抗体尤其是术后新生抗HLA抗体与CAN的发生密切相关,其中抗HLAⅡ类抗体在CAN的发生发展中起着重要作用.

HIF-1是目前发现的一个在特异性缺氧状态下发挥活性的转录因子，广泛存在于缺氧条件下的哺乳动物和人体内，可以调控许多靶基因的转录，具有许多生物学效应。研究表明其在肾组织细胞中有广泛表达，在肾缺血再灌注过程中起一定的保护作用，随着对HIF-1研究的不断深入及对缺氧缺血性肾脏损伤的机制的理解，相信可通过HIF-1途径进行干预，以期达到改善缺血性肾损害。

肾癌是泌尿系统最常见的肿瘤之一,除手术治疗外,放疗、化疗及激素治疗均不敏感,生物靶向治疗有一定的作用.本研究旨在探计肾肿瘤组织中APC基因、CXR32基因、TIMP-3或因启动子的甲基化状况,观察其在肾脏肿廇 发生中的可能作用。

目的评价双水平气道正压(BiPAP)无创通气治疗肾移植术后并发急性肺损伤(ALI)的临床效果。方法对56例肾移植术后合并ALI患者采用BiPAP呼吸机治疗结果进行回顾性总结,分析BiPAP呼吸机治疗前后患者生命体征(呼吸、心率、血压)及动脉血氧分压、二氧化碳分压的变化。结果 49例患者经无创通气治疗后生命体征、动脉血氧分压指标显著改善。7例因病情重改用气管插管有创通气。结论 BiPAP无创通气治疗肾移植术后并发ALI能改善患者低氧血症,改善其呼吸困难症状,可显著降低对气管插管的需求。

Objective:To investigate the methylation of promoters of BHD,RASSF1A,SPINT2 genes in renal carcinoma tissues,and analyze its possible role on pathogenesis of renal carcinoma. Methods:Twenty-four samples of kidney tumor tissues including 19 samples of renal clear-cell carcinoma,2 samples of harmatoma and 3 samples of tumor-adjacent tissues were collected. Methylation-specific PCR was introduced to test the promoter methylation status in CpG island. Results:Anti-oncogene methylation was detected in all clear-cell carcinoma tissues. Among them,methylation in 3,2 and 1 anti-oncogene regions were detected in 3,9 and 7 samples,respectively. Methylation in One anti-oncogene region was detected in 1 of the 2 samples of harmatoma. Methylation in 2 anti-oncogenes regions were detected in 1 of 3 samples of tumor-adjacent tissue. BHD gene methylation was detected in 9 samples of clear-cell carcinoma,while RASSF1A gene methylation in 7 samples of clear-cell carcinoma and one sample of tumor-adjacent tissues,and SPINT2 gene methylation in 18 samples of clear-cell carcinoma,1 sample of harmatoma,and 1 sample of tumor-adjacent tissues. Conclusion:There are methylation of BHD,RASSF1A,SPINT2 gene promoters in renal carcinoma tissues. These anti-oncogenes methylation may play an important role in the pathogenesis of renal carcinoma.

<正>人类白细胞抗原G(HLA-G)属于非经典HLA-Ⅰ类分子,与经典HLA-Ⅰ类抗原不同,它组织分布局限,正常生理条件下HLA-G的表达与HLA其他抗原的普遍表达存在不同,仅限制性地表达在一些免疫赦免区,如母胎交界面、胸腺髓质间上皮细胞和眼球部分,病理状态下表达于感染、肿瘤细胞、自身免疫性疾病以及移植功能良好的情况下[1]。

目的探讨肾移植术后重症肺部感染患者HLA-G的表达及临床意义。方法回顾性分析了12例肾移植术后因急性排斥反应血肌酐未降至正常患者,肺部感染后因病情需要停用免疫抑制剂后HLA-G的表达情况及血肌酐的变化。结果12例患者因肾移植术后1次或多次急性排斥,移植肾功能未完全恢复,于术后1～3月出现肺部感染,给予抗炎等治疗,因病情需要停用免疫抑制剂,1周以后患者血肌酐反而逐步下降至正常,且移植肾功能恢复良好。结论肺部感染后HLA-G的上调表达有利于移植肾功能的恢复。

Objective To study the diagnosis, treatment and preventive measures of the pulmonary in-fection in the patients after kidney transplantation. Methods The clinical data of 71 cases with pulmonary in-fection following kidney transplantation were analyzed retrospectively. Results In 76. 06% (54/71) of patients the pulmonary infection occurred during 1～4 months after renal transplantation, 4-6 months, 12 cases (16.9%), >6 months,5 cases (7.04%). Pathogen was mainly cytomegalovirus and bacteria. Conclusion U-aually, the pulmonary infection after kidney transplantation were mixed infection of bacterium, progresses quickly and severely, early see a doctor, early diagnosis, Rational antibiotic therapy for pathogens ,Timely adjust immuno-suppression, providing combined therapy, are the key treatment strategies for a successful result.

Objective:To study the impact of the proportion of peripheral CD4~-CD25~(high) Treg cell(regulatory T cell,Treg) on systemic immunity of renal transplant recipients,and to provide experimental evidence that the at tered proportion of CD4~+ CD25~(high) Treg cell act a specific index for evaluating immune state of transplant recipi ents,forecasting rejection and infection.Methods:52 renal transplant recipients were divided into normal immunity group(26 cases),rejection group(17 cases) and infection group(9 cases) according the postoperative recovery of renal transplantation.The proportion of CD4~+ CD25~(high) Treg cell was determined by flow cytometry.And related results analyzed then were analyzed.Results:The proportion of CD4~-CD25~(high) Treg cell in acute rejection group significantly lower than that in normal immunity group(P<0.05),the peripheral CD4~+ CD25~(high) Treg cell in in fection group significant higher than that in normal group(P<0.01).and all the differences statistical were sig nificant.On the other hand,the impact of FK 506 and CsA on CD4~-CD25~(high) Treg cell was not of statistical significant. Conclusions:In postoperative renal transplant recipients,the proportion of peripheral CD4~+ CD25~(high) Treg cell is closely related to their immune state.The changes of the proportion of peripheral CD4~+ CD25~(high) Treg cell can reflect the alter of their immune status,and it can work as one of the parameters for predicting infection or rejection on renal transplant recipients.