摘要
目的探讨移植肾功能延迟恢复（DGF）伴急性排斥反应的临床诊断与治疗。方法总结我院6年来275例次肾移植患者，28例术后出现DGF，综合肾穿刺活检、移植肾彩超及临床情况而确定为DGF合并急性排斥反应13例，确定DGF合并急性排斥反应后即用甲基强的松龙（MP）冲击治疗，2例冲击治疗效果不佳，即使用ATG治疗，2例MP冲击治疗后血肌酐再度升高者，将环孢素A改为FK506。结果诊断DGF合并急性排斥时，13例患者血肌酐水平在267～748μmol/L，均在治疗后8～15d降至〈200μmol/L，随访3个月除1例患者于肾功能恢复正常后1个月死于肺部感染外，10例患者血肌酐正常，2例患者血肌酐在140～190μmol／L。结论早期行移植肾穿刺活检非常重要，确诊后应减少肾毒性药物，使用MP冲击治疗，对MP冲击治疗效果不佳者，可用ATG、FK506，效果良好。
Objective To investigate the diagnose and treatment of delayed graft function with acute rejection after renal transplantation. Methods 275 cases of renal transplant recipients were retrospectively analyzed in recent 6 years. Among 28 cases, 13 cases were diagnosed acute rejection on the bases of DGF according to allograft biopsy, ultrasound, and clinical dates. Once the diagnose was ensured, high-dose of methylprednisolone （MP） was prescribed immediately. Two recipients were treated with ATG as acute rejection did not be controlled. CsA was moditied by FK506 in two recipients as serum creatinine （SCr） ascended again. Results SCr before treatment was 267～748μmol/L in these 13 recipients. SCr decreased to a level below 200μmol/L after 8～15 days of treatment. The renal function became normal in 10 patients after 3 months of fellow-up. There was one case died of pulmonary infection 1 month after the renal function became normal, while the SCr of the rest two eases decreased to 140～190μmol/L. Conclusion It is important to biopsy in early episode. Nephrotoxieifieal agents should be reduced and high-dose of MP should be prescribed once diagnose was ensured. If MP did not got a good result, ATG, FK506 may be effective in suppressing the development of AR.
出处
《四川医学》
CAS
2006年第10期1053-1054,共2页
Sichuan Medical Journal
关键词
肾功能延迟恢复
急性排斥
delayed graft function
acute rejection
