抗中性粒细胞胞质抗体相关肾炎患者肾移植的转归

发布时间：2019-01-14 10:52

【摘要】：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。
[Abstract]:Aim: to retrospectively analyze the outcome of renal transplantation in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN). Methods: renal transplantation was performed in 11 patients with AAGN [4 males and 7 females with a median age of 48 (33.5 卤52.5) years]. Steroids, metocophenolate mofetil and tacrolimus / cyclosporine A combined anti-rejection therapy were used. The rejection and its types after renal transplantation were all diagnosed by biopsy. The prognosis, recurrence of vasculitis and serum ANCA were analyzed retrospectively. Results: 11 cases of AAGN were MPO-ANCA associated vasculitis, 10 cases received renal replacement therapy before renal transplantation, the median time was 30.5 (14.8 卤50.5) months. There was no vasculitis activity (BVAS 0) before renal transplantation, and 7 cases were positive for serum MPO-ANCA. 4 cases (36.4%) developed acute cellular rejection, and 1 case developed recurrent vasculitis and chronic humoral rejection at 18 months and 22 months, respectively. The median follow-up was 56 months (46.5 卤135 months). At the end of follow-up, the serum creatinine levels were normal in 8 cases (72.7%), elevated in 2 cases, and dysfunction in 1 case. The renal survival rate was 100% and 90.9% in 5 year patients, respectively. There was no significant difference in the incidence of graft rejection and the recurrence rate of vasculitis between ANCA positive and negative patients before operation. Conclusion: the long term prognosis and recurrence rate of vasculitis in AAGN patients are good, but the incidence of early acute rejection is high. The prevention of anti rejection should be strengthened.
【作者单位】：南京总医院肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所;
【基金】：国家临床重点专科军队建设项目肾脏科专项(2014ZDZK001) 国家科技支撑计划课题(2015BAI12B05,2015BAI12B02)
【分类号】：R699.2

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