肾移植术后多瘤病毒相关性肾病的单中心回顾性研究

发布时间：2018-07-04 15:51

本文选题：肾移植 + 多瘤病毒　；参考：《浙江大学》2014年硕士论文

【摘要】：目的：总结我科单中心肾移植术后多瘤病毒相关性肾病(polyomavirus associated nephropathy, PVAN)的临床表现、诊治及预后,以利更有效地做好后续相应防治工作,提高移植肾及受者的存活率。方法：选取2011年7月至2013年12月在浙江大学附属第一医院肾脏病中心病理确诊为PVAN的肾移植受者26例,回顾性分析其临床资料,对临床表现、诊断及治疗转归进行分析总结。结果：在26例PVAN的肾移植受者中,男性14例,女性12例,手术时平均年龄在35岁(21-50岁),92.3%(24/26)肾脏原发病为慢性肾小球肾炎；尸体供肾14例,亲属活体供肾12例。平均HLA总错配数为2.7,2例受者术前PRA阳性,1例受者为2次肾移植。21例受者接受了术前免疫诱导。病理确诊PVAN的中位术后时间为10个月(2-60个月)。临床上均表现为血肌酐进行性升高。4例受者合并有蛋白尿和/或血尿,其余22例受者无蛋白尿及血尿。3例受者合并有输尿管狭窄、移植肾积水。行移植肾活检同时,16例受者进行了decoy细胞检测,75%(12/16)的受者decoy阳性。5例受者诊断PVAN前有急性排斥反应史,2例受者诊断时合并有急性排斥反应。确诊后通过下调免疫抑制剂强度,1例受者切换药物时因伴发严重的肺部感染而带功死亡。其余25例受者经过17个月(3-29个月)的中位随访时间,72%(18/25)的受者肾功能稳定或好转,其中2例血肌酐降至基线水平。7例受者的肾功能进展,其中3例出现移植肾失功。对规律随访的25例患者进行Kaplan-Meier生存分析,结果显示：确诊时及确诊后合并急性排斥反应组预后较未合并组差,两者的差异具有统计学意义(P=0.002)。结论： PVAN发病早,预后差,严重影响移植肾的长期存活。确诊后调整免疫抑制方案降低免疫抑制剂强度能使大部分受者肾功能保持稳定。合并有急性排斥反应者预后较差。
[Abstract]:Objective: to summarize the clinical manifestations, diagnosis, treatment and prognosis of (polyomavirus associated nephropathy, PVAN after single center renal transplantation in our department, so as to improve the survival rate of the recipients. Methods: from July 2011 to December 2013, 26 renal transplant recipients who were pathologically diagnosed as PVAN in the Nephrology Center of the first affiliated Hospital of Zhejiang University were selected and their clinical data were retrospectively analyzed. Diagnosis and treatment were analyzed and summarized. Results: among the 26 recipients of PVAN, 14 were male and 12 were female. The mean age at the time of operation was 92.3% (24 / 26) with chronic glomerulonephritis, 14 with cadaveric kidney and 12 with living donor kidney. The average total mismatch of HLA was 2.7% in 2 recipients. One recipient received two renal transplants. 21 recipients received preoperative immune induction. The median postoperative time for pathologically confirmed PVAN was 10 months (2-60 months). The clinical manifestations were progressive elevation of serum creatinine in 4 recipients with proteinuria and / or hematuria, the other 22 patients without proteinuria and hematuria with ureteral stenosis and hydronephrosis. Renal transplantation biopsy was performed in 16 recipients. 75% (12 / 16) of the recipients were positive for decoy. There were 2 cases with acute rejection before diagnosis and 2 cases were diagnosed with acute rejection. After diagnosis, one recipient died of severe pulmonary infection by decreasing the intensity of immunosuppressive agents. In the remaining 25 recipients, the renal function was stable or improved in 72% (18 / 25) of the recipients after 17 months (3-29 months) of median follow-up time. Kaplan-Meier survival analysis was carried out in 25 patients with regular follow-up. The results showed that the prognosis of the patients with acute rejection at the time of diagnosis and after diagnosis was worse than that of the group without acute rejection (P0. 002). Conclusion: PVAN has early onset and poor prognosis, which seriously affects the long-term survival of transplanted kidney. After diagnosis, adjusting immunosuppressive regimen and decreasing the intensity of immunosuppressive agents can stabilize the renal function of most recipients. The prognosis of patients with acute rejection was poor.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

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